Alpha-fetoprotein (AFP) is a blood-based biomarker that’s used together with ultrasound to detect liver cancer, but it’s by no means a perfect test. Experts are hopeful that emerging, specific blood-based biomarkers will prove useful in liver cancer surveillance — potentially as stand-alone tests.

Quick Summary

HCC is a leading cause of cancer mortality in Asia. Causes of HCC include viral hepatitis B and C infections, with recent increases in metabolic disorders, such as NAFLD, also playing a factor.

Early HCC interventions are highly effective and can lead to improved patient outcomes and survival. Therefore, HCC surveillance programs are pivotal in detecting HCC early and making the appropriate interventions.

In this whitepaper, HCC surveillance programs in Asia were analysed. The learnings from well established HCC surveillance programs in Asia, as well as the challenges in areas that have not implemented such programs have highlighted 7 priorities for implementing an HCC surveillance program:

1. Include HCC surveillance in national program and strategic plans
   HCC surveillance programs should be fit into the national health strategy where appropriate, taking into account the local incidence and prevelance rates, and existing priorities and resources.
2. Secure sustainable funding commitments
   Long-term resourcing and financing is key to making HCC survaillance programs successful. The current health financign system in the area, and ability to pay should be assessed, while exploring various funding methods such as centralised healthcare coverage or private insurance.
3. Collect, analyse, and utilise data to inform program design
   The development of HCC surveillance program should be based on data, such as HCC epidemiology, patient outcomes, human and economic cost of HCC. These data should be collected and analysed.
4. Adopt optimal technologies to advance HCC surveillance
   Technology can help to improve access to HCC surveillance programs, as well as improve patient outcomes by detecting HCC early. Some examples include: including additional biomarkers such as PIVKA-II, using biomarker based digital algorithms and diagnostic models, using more advanced imaging techniques, and adapting IT systems to support surveillance programs.
5. Mobilise existing resources for HCC surveillance
   Tapping on exisiting resources to expand capacity for HCC care and surveillance., For example increasing the range of HCPs who can diagnose and manage HCC like primary and community HCPs, expanding private healthcare capacity in HCC care.
6. Engage a broad spectrum of stakeholders to further surveillance goals
   Governmental decision-makers, physicians, patients and PAGs, payers and industry need to come together to drive implementation of a robust HCC surveillance programs that address needs of all stakeholders.
7. Raise awareness and provide education on the need for HCC suveillance
   Raising the knowledge among the general population and HCPs on HCC and the importance of surveillance can improve uptake and compliance to surveillance programs.

Quick Summary

Biomarkers are biological molecules found in blood, other body fluids or tissues that can indicate a normal or abnormal process, condition, or disease. They play an important role in the clinical management of cancer patients by facilitating risk stratification, early detection, diagnosis, and prediction of prognosis or treatment response. In hepatocellular carcinoma (HCC), there is a need for better biomarkers to stratify patients at different stages of clinical management. Guidelines such as the Tumor Marker Utility Grading System (TMGUS) and the Reporting recommendations for tumor marker prognostic studies (REMARK) provide useful frameworks for biomarker development and validation in cancer. However, modifications may be required for specific clinical scenarios, such as risk stratification and treatment response assessment in HCC. To address these issues, the International Liver Cancer Association has assembled a group of experts on biomarker development to provide a framework on best practices for biomarker studies in HCC.

Authors: Amit G. Singal, Yujin Hoshida, David J. Pinato, Jorge Marrero, Jean-Charles Nault, Valerie Paradis, Nabihah Tayob, Morris Sherman, Young Suk Lim, Ziding Feng, Anna S. Lok, Jo Ann Rinaudo, Sudhir Srivastava, Josep Llovet, Augusto Villanueva