#OctoberIs4Livers campaign draws awareness to health inequities in liver cancer care

Every October marks Liver Cancer Awareness Month in an effort to raise awareness and improve advocacy and treatment for patients living with the disease.

Liver cancer is the sixth most common cancer worldwide and the third leading cause of cancer death, according to information from the NCI. Moreover, data indicate the incidence of liver cancer is rising, with approximately 41,630 new cases and as many as 29,840 expected deaths this year in the U.S.

The most common type of liver cancer in adults is hepatocellular carcinoma, which is more common in men than women and among Asian American/Pacific Islanders and Native American/Alaska Natives.

Similarly to last year, The Global Liver Institute has launched a social media campaign with the hashtag, #OctoberIs4Livers to educate the public on early symptoms and detection, liver cancer within diverse communities and addressing care hindrances. This year’s campaign specifically aims to address disparities in liver cancer care, with a particular focus on rural communities, American Indian and Indigenous People in Canada, and U.S. veterans.

Healio recognizes Liver Cancer Awareness Month by revisiting the latest news and research on early detection, new therapies for HCC, the importance of up-to-date screening and major risk factors.

HCC screening linked to reduced mortality but remains ‘underused in clinical practice’

HCC screening in at-risk patients was linked to reduced mortality after accounting for lead-time and length-time biases, as well as improved early tumor detection and treatment, according to data in JAMA Network Open.

“Although there have been several studies examining the value of HCC screening in patients with cirrhosis, there continues to be debate if this is beneficial,” Amit G. Singal, MD, MS, medical director of the liver tumor program and chief of hepatology at UT Southwestern Medical Center, told Healio. “Indeed, hepatology professional society guidelines recommend screening, but this has not yet been adopted by larger societies. This discrepancy is partly due to the lack of randomized data and the practice only being supported by cohort studies that have inherent limitations including lead time bias, length time bias and residual confounding.” Read more.

Bulevirtide monotherapy ‘may prevent decompensation but not HCC’ in HDV, cirrhosis

Over 2 years, bulevirtide (Gilead) monotherapy reduced the risk for decompensation and mortality, but not HCC, among patients with hepatitis D virus and compensated cirrhosis compared with untreated patients, according to data presented at EASL Congress.

“Bulevirtide, the first-in-class entry inhibitor, has been approved by EMA for treatment of compensated chronic hepatitis delta,” Elisabetta Degasperi, MD, PhD, of the division of gastroenterology and hepatology at Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, said during her presentation. “In phase 2 and 3 clinical trials and real-life studies, bulevirtide monotherapy yielded high rates of virological and biochemical response, also in patients with cirrhosis.” Read more.

Risk score has ‘superior ability’ to predict LT waitlist dropout among patients with HCC

A continuous risk score accurately predicted waitlist dropout and post-liver transplantation outcomes in patients with HCC, even over the course of several UNOS policy changes, researchers reported.

“Multiple policy updates to the exception point system have been needed to adjust for practice changes and to balance transplant equity between HCC and non-HCC patients,” Miho Akabane, MD, of the division of abdominal transplant at Stanford University Medical Center, and colleagues wrote in Clinical Gastroenterology and Hepatology. “The Hazard Associated with LT for HCC (HALT-HCC) score has been previously reported as an effective continuous metric for predicting various outcomes in LT for HCC, including response to locoregional therapy and post-LT recurrence and survival, offering advantages over dichotomous morphology-based scores.” Read more.

Up-to-date HCC screening after HCV cure improves survival in patients with cirrhosis

Remaining current on screening for HCC correlated with a survival benefit in older adults with hepatitis C virus-related cirrhosis who achieved viral cure but later developed HCC, according to researchers.

“Multiple observational studies have demonstrated associations of HCC screening, consisting of semiannual imaging and alpha-fetoprotein measurement, with improved detection of early-stage HCC, receipt of curative treatment and overall survival,” Catherine Mezzacappa, MD, of the division of digestive diseases at Yale School of Medicine, and colleagues wrote in JAMA Network Open. “Individuals with HCV-associated cirrhosis who have achieved viral cure may be particularly susceptible to lapses in HCC screening due to treatment-induced stabilization of their liver disease. However, data on clinical HCC screening practices and outcomes in these patients are sparse.” Read more.

Model may ‘serve as a starting point’ to identify patients with MASLD at high risk for HCC

A prediction model could be a “starting point” to identify patients with metabolic dysfunction-associated steatotic liver disease at high risk for HCC who may require intervention or surveillance, researchers wrote in JAMA Network Open.

“Despite known MASLD-related HCC risk factors, few prediction models have been developed in MASLD populations, primarily using genetic risk scores, limiting their applicability in routine clinical settings, or in racially and ethnically homogeneous populations,” Luis A. Rodriguez, PhD, of the division of research at Kaiser Permanente Northern California, and colleagues wrote. “Thus, there is a need to develop risk stratification tools using routinely collected demographic and clinical variables from diverse populations in clinical settings to identify a subgroup of patients with high-risk MASLD with and without cirrhosis in whom HCC surveillance can be prioritized.” Read more.

Even with HCV cure, surveillance for portal hypertension, HCC ‘should be mandatory’

Despite achieving cure with direct-acting antivirals, patients with chronic HCV-related decompensated cirrhosis remain at risk for progression of portal hypertension, further decompensation and HCC, according to a study published in Gastroenterology.

“The introduction of pan-genotypic, highly effective DAAs has transformed the therapeutic paradigm towards HCV elimination,” Madhumita Premkumar, MD, DM, associate professor of hepatology at the Postgraduate Institute of Medical Education and Research in Chandigarh, India, and colleagues wrote. “In this study, we assessed the real-world efficacy of a programmatic provision of free-of-charge DAA therapy for management of decompensated chronic HCV-related cirrhosis in a public health care setting in the Punjab state, India.” Read more.

Early declines in serum hepatitis B RNA levels may ‘serve as independent predictors’ of HCC

Declines in serum hepatitis B virus RNA at the first and second year of treatment with nucleos(t)ide analogues correlated with risk for HCC and may serve as independent predictors of cancer development.

“Long-term nucleos(t)ide analogue (NA) treatment can significantly decrease but cannot eliminate the HCC risk,” Shi Liu, of Southern Medical University in Guangzhou, China, and colleagues wrote in Clinical Gastroenterology and Hepatology. “Existing HCC risk-prediction scores established in NA-treated patients, such as PAGE B, modified PAGE B and aMAP score, only included commonly measured clinical parameters, such as age, sex, platelet and albumin.” Read more.

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