Alive thanks to innovative research

Serges Bériault’s life changed in 2012, when he was diagnosed with a bile duct cancer of the liver. The father of two children and active professional finishing an MBA never thought an army of specialists at the McGill University Health Centre (MUHC) would get him through a complex and innovative research protocol that saved his life.

“When I received my diagnosis, I had to make a decision quickly. The form of cancer I was suffering from is very rare and my chances of survival were close to zero,” says Serges. “My doctors told me the only treatment option was a new clinical research project developed by the Mayo Clinic in the United States.”

Even if it was still at an experimental stage, Serges decided to go through with it at the MUHC to stay close to his wife and family. “I also had confidence in the clinical team at the Royal Victoria Hospital (RVH-MUHC),” he says. Serges was first diagnosed with primary sclerosing cholangitis (PSC), a disease in which the bile ducts – small tubes through which the digestive liquid bile flows from the liver to the small intestine – progressively decrease in size due to inflammation and scarring. At that time he was told by his gastroenterologist he would need a liver transplant in the future, but since no date was confirmed, he went on with his life.

A few months later, a biopsy was the bearer of bad news. Serges learned he had hilar cholangiocarninoma. This rare form of cancer is often difficult to treat because tumours develop where the right and left hepatic bile ducts come together, and often, they cannot be surgically removed. Serges was immediately seen by Dr. George Zogopoulos, an MUHC surgeon who specializes in hepato-pancreato-biliary and transplant surgery and who is a researcher in the Cancer Program of the Research Institute of the MUHC (RI-MUHC). It was the beginning of a long journey.

A case requiring high-level expertise

“We could not operate on Serges because the cancer was located right in the middle of the bile ducts and his liver disease made it more complicated,’’ explains Dr. Zogopoulos.”I had research interest in this special protocol and I knew we had the expertise at the MUHC and the Research Institute to do it, even if it had never been successfully completed in the past here. So, when Serges decided to stay in Montreal, we championed it, put together a multidisciplinary team and got Serges admitted to the hospital to follow the treatment.’’

Serges had to pass a battery of tests to be able to take part in the protocol. “They performed exams on my heart, my bones, my gall-bladder, my eyes and skin,” he recalls. “The clinical team was very professional and compassionate. They never made me feel like I was ‘the first patient’ to undergo this research protocol at the MUHC.”

Over a period of three months, more than 20 people including nurses, transplant surgeons, oncologists and radiologists worked day and night with Serges. The protocol, which combined radiation therapy along with chemotherapy and a liver transplant, required different steps almost every single day.

Dr. Zogopoulos collaborated with MUHC gastro-hepatologist Dr. Peter Ghali, who had completed a fellowship in Hepatology and Liver Transplantation at the Mayo Clinic. On top of working with MUHC experts in their respective fields such as Dr. Jamil Asselah, medical oncologist, Dr. David Valenti, radiologist, and Dr. Neil Kopek, radio-oncologist, they were in regular contact with research leaders abroad to get guidance on Serges’ unique case.

“The key to success is not just having the expertise but allowing experts to interact frequently; it is the communication that makes all the difference,” says Dr. Peter Ghali, who is also a researcher from the Experimental Therapeutics and Metabolism Program of the RI-MUHC. Medical updates on Serges’ condition had to be done daily and at a very high level of expertise. You need the hospital to be able to put these specialized services under one roof, which is exactly what we have right now at the Glen. And that is why it worked.”

Against all odds

After successfully completing the radiation and chemotherapy treatments, doctors had to make sure Serges’cancer had not spread. Once confirmed, he finally received his liver transplant. Unfortunately, he developed a severe postoperative infection, and his hospital stay was extended.

“I remember being quite sick in my hospital room and Dr. Zogopoulos came back on a weekend to perform emergency surgery. There was no time to waste,” says Serges. “As I was taken to the operating room, the clinical staff started clapping their hands to encourage me. It was a very touching moment. It gave me the strength I needed at that point.”

Serges stayed seven months in the hospital. He now has a perfectly functional liver and sees Dr. Zogopoulos regularly to make sure there is no recurrence of cancer.

“In Canada, there are only two centres offering this protocol and the MUHC is one of them,” adds Dr. Ghali.”Thanks to this protocol, the survival rate can be as high as 80 per cent, if you treat the patient early enough. That’s truly remarkable for somebody who in the past had zero chance of survival.”

According to Dr. Zogopoulos, this case is in fact a perfect example of the kind of individualized care at its highest level we provide at the MUHC.

“This is who we are: a university hospital with the mandate to advance care through research and clinical innovation and by learning from each patient as we implement these innovations,” adds Dr. Zogopoulos “As we move forward, we hope to be able to identify different types of cancer and develop customized treatments to help more patients who suffer from rare and complex forms of cancer.”

Thanks to clinical innovation, the MUHC and RI-MUHC team of specialists improved Serge’s protocol and since then, another patient who was diagnosed with the same type of cancer has started it. Her meeting with Serges was a key element in her decision to join the protocol.

“On top of being able to help advance cancer research,” says Serges, who has been cancer free for almost three years now, “my greatest satisfaction was to be able to help this young woman and recently see her smile at a gala fundraiser.”