The American Italian Cancer Foundation continues to sponsor the work of Italian scientists through its Post-doc Research Fellowship program. Since 1983, the New York-based organization has supported hundreds of scientists in the field of cancer biology and treatment. La Voce sat down with Dr. Remo Alessandris, a physican at Memorial Sloan Kettering Cancer Center in Manhattan, who works in surgery and is also conducting research into liver cancer thanks to a fellowship from the AICF.
Dr. Alessandris, please tell us a bit about yourself.
My name is Remo Alessandris, I’m 34, and I’m a research fellow at Memorial Sloan Kettering Cancer Center here in New York. I am mainly involved in studies in the area of hepatobiliary (liver and bile duct) surgery, because I started out first as a physician and then went into surgery, having specialized in November 2024 at the University of Padua, in general surgery with a focus in hepatobiliary surgery. During the last year of residency, I had the opportunity to come here to Memorial Sloan Kettering as a Research Fellow. I’m just doing research, since I still do not have the ECFMG certification needed to work as a physician in the US – this certification is the standard for evaluating the qualifications of international medical graduates (IMGs) entering the U.S. health care system. This is why my dream, my next step really: to become a clinical fellow in surgical oncology, and I’m studying to get this certification in order to apply for that position here at MSK, at the HPB—hepatopancreatobiliary service—under the mentorship of the two leading international experts of hepatobiliary surgery, who are Dr. Jarnagin and Dr. D’Angelica.
During this period, I became passionate about clinical and basic research as well. I had the opportunity to start attending another laboratory at Memorial, that of Dr. Andrea Ventura, who is a member of the Cancer biology and genetics program, where he studies extrachromosomal circular DNA (ecDNA). His lab was one of the first to be able to developed the first IN VIVO approach to model focal oncogene amplifications mediated by extrachromosomal circular DNAs. This is a class of mutation of great clinical relevance that have only recently been discovered. They are getting a lot of attention in the scientific community because they have been found to be associated with some of the more advanced, more aggressive cancers, but there is actually not that much literature regarding hepatobiliary cancers.
Would you say this puts you on the cutting edge?
I’d say so. Having approached Andrea Ventura’s lab gave me the opportunity to start this translational journey from basic science to clinical science, because my project is focused on translating the results obtained in the lab with clinical results.
How did you get involved with the American Italian Cancer Foundation?
My connection with AICF began about six months ago. Seeing Dr. Ventura’s work, I became passionate about this subject, and I came up with a research project with him, aimed at better understanding the prevalence of this type of genetic alteration —extrachromosomal circular DNA-mediated oncogene amplification— in the context of hepatobiliary cancers. Consequently, after defining the prevalence of these alterations, the next step is to look at it with the prognosis of the patient, and to see then whether patients with ecDNA have a worse or better prognosis than those with focal amplification on the chromosome. This project with Dr. Ventura allowed me to earn a Fellowship with the American Italian Cancer Foundation, so I can continue my path here at Memorial Sloan Kettering for another year, to further this research.
A lot of people dream of being a doctor from a young age, is that also your story?
I became interested in the field of medicine in my last years of high school. As for a reason… well, there’s no real reason, because I don’t have any doctors in my family who could get me interested in the subject. I kind of took it more as a challenge, then in the course of my studies in medicine, I became passionate in the area of surgery, because I am a person who likes to fix things, put everything in its place. And then there’s the gratification that one has in treating and in helping patients. It’s a gift for me to do it in a hands-on way, directly in the operating room, to come out of the operating room, and tell the patient, “okay, everything went well, we took out what needed to be taken out.”
Can you tell us a bit more about your work in surgery?
What I was able to explore here at the MSK Cancer Center is one of the treatments that MSK pioneered, which is hepatic intra-arterial infusional chemotherapy, for the treatment of both colorectal liver metastases and intra-hepatic cholangiocarcinoma. This is a type of treatment that allows us to treat patients who are unresectable (i.e. not candidates for curative surgery), and would otherwise be treated only with systemic chemotherapy. For patients whose disease is confined to the liver or biliary tract, this localized intra-arterial therapy offers an additional, targeted treatment option.
There is first a surgical procedure that involves implanting a pump with a catheter leading into the hepatic artery. This catheter delivers the drug directly into the liver, targeting where the tumor is. The drug gets to the liver, not broadening out to the systemic level. This treatment is able to greatly prolong patient survival, allowing some patients a five-year survival rate, which is not possible with systemic chemotherapy alone. This treatment is not yet done in Italy, and only one place in Europe that I know of, in Rotterdam.
What is it like to be in the operating room? Do you feel pressure?
Not necessarily. A clinical doctor knows what medicines to use, how they act, the dosage and so on. In the same way, a surgeon is also able to discern operable and inoperable cases, knows where he can put his hands and where not to, and so the job is comparable to the clinician. When it comes to tumors, where the surgeon can intervene and remove the tumor is often the main curative treatment. In the case of systemic chemotherapy—except for some types of treatment that I’m not personally familiar with–in most cases systemic chemotherapy is purely palliative. Maybe the patient responds very well to chemotherapy, and that allows them to be operable when maybe they were not operable before.
Who is mainly affected by liver cancer?
Most patients are in their 60s or older, and men are generally at a higher risk of being affected than women.
As for your plans for the future, do you think you might stay in the United States permanently or do you have a desire to transfer your knowledge to the Italian sphere?
New York and America are fascinating places, but for me Italy is more so. Going back to Italy would allow me to be close to family, and still continue this academic path.
What do you love most about your work?
My greatest satisfaction is to be able to relate on a daily basis to people who do the research, in the United States but more importantly around the world. Being in contact with these people allows you to broaden your horizons.
