Prof MF Yuen & Ronald Lo discuss the liver health ecosystem in Hong Kong, including hepatitis screening and HCC surveillance

Find out more about PIVKA-II in Hepatocellular Carcinoma (HCC) detection, or download our HCC Detection (HD) expert pack by filling in the form below:

Interview transcript:

Ronald Lo:

Hello everyone! Welcome to this video. I’m Ronald, the General Manager of Roche Diagnostics Hong Kong. It’s my honour today to invite Professor Yuen to have a discussion around the topics of hepatitis and hepatocellular carcinoma (HCC). Hello Professor Yuen.

Prof. MF Yuen:

Hi, I am Professor MF Yuen, the Chief of Division of Gastroenterology and Hepatology in the University of Hong Kong.

Ronald Lo:

Again, thank you so much for joining us today. So the first question I would like to get your advice would be, what is the current liver health landscape in Hong Kong; and what are the unmet needs in hepatitis screening and HCC detection in Hong Kong?

Prof. MF Yuen:

At present, Hong Kong still has a high prevalence of 7.8% hepatitis B population, amounting more than 550,000 people. According to the most recent statistics, there were more than 1,700 new cases of liver cancer in 2020. And it is known that more than 80% of Hepatocellular Carcinoma are caused by Hepatitis B infection. Even with this high rate, we do not have population screening program for Hepatitis B infection, and the surveillance for HCC is also suboptimal with respect to the lack of routine regular ultrasound of the liver for Hepatitis B patients. It is mainly due to manpower and financial constraint in the public hospital sector. On top of all these, we do not have a well-organised strategy to deliver disease information to our population. Majority of people do not know the serious disease consequence of Hepatitis B infection which may lead to early death. They also lack of knowledge of early treatment would prevent all these deleterious outcomes.

Ronald Lo:

So I would like to learn from you more, what are the recent advances in the diagnosis of HCC; and how do you see these impacting patient care and the chronic liver disease management in Hong Kong?

Prof. MF Yuen:

From Asian experience, the use of additional biomarkers, such as PIVKA-II, can significantly increase the pick-up rate of HCC at early stage, increase the likelihood for curative treatments, and thus improve the survival. New digital algorithms combining age, gender and biomarkers, such as GAAD and GALAD, have been proposed since 2013, and currently undergoing clinical validations. Recent data presented during APASL 2023 demonstrated that the use of PIVKA-II based algorithm is more cost-effective than current standard of care among Hepatitis B or cirrhotic patients in Hong Kong, which allows an earlier HCC detection and a reduced cost in subsequent HCC treatment.

Ronald Lo:

Let’s switch the gear a bit. So how do you think we can improve the coordination and integration of care among various healthcare providers and systems?

Prof. MF Yuen:

I think the most important step would be the active involvement of different concerned parties, including health care sectors from government, private institutions, policy makers, patient groups, and different NGOs, to establish a core committee which could liaise with different stakeholders to ensure the implementation of different measures to enhance diagnosis rate, screening strategy and treatment.

Ronald Lo:

And to add on, how do you see the future of liver health in Hong Kong, and what steps do you believe need to be taken to improve the patient outcomes?

Prof. MF Yuen:

The future of liver health in Hong Kong depends on whether we could have a statutory body which taking charge of planning, liaising and implementing different measures at different levels.

Ronald Lo:

Thank you Professor. So probably would be my last question. So how do you see the role of the government and the policy in addressing the liver health ecosystem?

Prof. MF Yuen:

Hong Kong government has been working on different policy making processes and decisions by involving different committees. However, the decisiveness should be more enhanced so that policy can be rolled out at a timely manner.

Ronald Lo:

Professor Yuen, thank you so much for your time today and your inspiring insights on the topics of hepatitis and HCC. And I’m sure that there are always many areas that we could further work on together to improve patient outcomes. And thanks a lot for contributing to the “Combating Cancer” educational platform as well. Thank you so much, thank you!

The views and opinions expressed by Prof. MF Yuen are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.

Prof Henry LY Chan discusses liver cancer tumor markers for early HCC detection

Find out more about PIVKA-II in Hepatocellular Carcinoma (HCC) detection, or download our HCC Detection (HD) expert pack by filling in the form below:

Interview transcript:

Introduction

I am Professor Henry Chan, a honorary clinical professor of the Chinese University of Hong Kong and deputy chief hospital manager of Union Hospital Hong Kong.

What is the unmet need in HCC surveillance and diagnosis?

Liver cancer is the 5^th commonest cancer and 3^rd commonest cancer mortality in Hong Kong. Most patients suffering from liver cancer are having underlying chronic liver disease such as viral hepatitis or fatty liver. As early liver cancer has no symptoms, regular surveillance is required to pick up small cancer, which are potentially curable by liver resection or loco-ablative therapy. On the other hand, systemic therapy for advanced liver cancer is not a very successful option. As patients with chronic liver disease are usually asymptomatic, one challenge on HCC surveillance is adherence of these patients to a regular program. Patient education and convenient testing will be pivotal to the success of HCC surveillance.

What is your current HCC surveillance practice and how is PIVKA-II implemented?

The standard tests for HCC surveillance is ultrasound of the liver and alfa-fetoprotein testing. The recommended interval of surveillance is 6 months to match the tumor doubling time of HCC. As there are limitations for both ultrasound and alfa-fetoprotein, these 2 investigations should be used together. For example, ultrasound may be difficult in patients with liver cirrhosis or obesity. On the other hand, alfa-fetoprotein may have limited sensitivity for small HCC. PIVKA II is a biomarker elevated in HCC with a completely different mechanism as AFP. There are ample data suggesting that testing AFP and PIVKA II together can improve the sensitivity for small HCC.

What clinical situations do you think are the most appropriate to use PIVKA-II for HCC surveillance?

There are data from Japan and China suggesting that AFP is not as sensitive as PIVKA II to detect small HCC in patients with alcohol-related liver disease and non-alcoholic fatty liver disease. Although more studies may be needed to confirm this finding, PIVKA II may be a good biomarker for HCC in patients with liver cirrhosis secondary to these 2 conditions. Another group of patients are those known to have difficult ultrasound, including obese patients and patients with cirrhotic nodules. Adding PIVKA II to the HCC surveillance program may compensate the inadequacy of USG. Ultimately, if cost is not a concern, I think PIVKA II should be used together with AFP in all patients for HCC surveillance.

What are your expectations for digital algorithms that aid in diagnosis of HCC, and how can they add value to overall clinical decisions in addition to biomarkers?

A digital algorithm composed of biomarkers and clinical parameters can generate a single score to inform the probability of HCC. It can facilitate a simple interpretation of the biomarker results in the context of the patients, and will be particularly useful for non-experts to carry out HCC surveillance. One challenge to implement digital algorithms is the education of clinical practitioners to interpret the meaning of the scores.

What advice would you give to your fellow colleagues?

When I was working in the public hospital, I was annoyed by the long waiting time for an ultrasound, which may take up to 2 years. I think PIVKA II is a good alternative for this unmet need. Using PIVKA II together with AFP can improve the sensitivity to pick up early HCC during this window period without ultrasound. This is particularly important for patients with alcohol-related liver disease and non-alcoholic fatty liver when the sensitivity of AFP for early HCC is low.

The views and opinions expressed by Prof. Henry LY Chan are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.

Prof Ming-Lung Yu shares his clinical experience using PIVKA-II to complement AFP & ultrasound for early HCC detection

Find out more about PIVKA-II in Hepatocellular Carcinoma (HCC) detection, or download our HCC Detection (HD) expert pack by filling in the form below:

Interview transcript:

Introduction

Hello everyone, I am Dr. Ming-Lung Yu. Currently I am a physician and Chair Professor of Hepatology at the Kaohsiung Medical University Hospital and Senior Vice President of National Sun Yat-sen University.

What is the unmet need in HCC surveillance and diagnosis?

There are about 11,000 new liver cancer patients in Taiwan every year. Unfortunately, 60% of liver cancers are advanced stage at the time of first diagnosis, and usually, the effect of treatment is not satisfactory. Patients with early-stage tumors, that can be removed surgically or by ablation, have the best chance of long-term survival. Therefore, early detections of liver cancers are crucial to increase patient outcome.

What is your current HCC surveillance practice and how is PIVKA-II implemented?

Ultrasound sonography is the most important and reliable screening tool, but its sensitivity will be affected by the size and location of nodules, operation technique, fatty liver, etc. Therefore, it needs serum biomarkers as an assistant tool. AFP has been used commonly in liver cancer diagnosis now. And PIVKA-II has been used more and more in daily practice recently since it became the reimbursed item.

Why was PIVKA-II implemented in your clinical practice?

There is cumulating evidence supporting the application of PIVKA-II for HCC diagnosis. And PIVKA-II combined with AFP and ultrasound sonography can improve the sensitivity of HCC surveillance, especially in early stage of HCC.

What is your clinical experience using PIVKA-II and how effective is it in your clinical practice in HCC surveillance and diagnosis?

We observed that PIVKA-II has good sensitivity & specificity in HCC patients, and it could be better when combined with AFP & ultrasound sonography.

For BCLC stage 0/A patients, we found PIVKA-II has the best sensitivity, compared to those of ultrasound sonography and AFP.

For example, some HCC patients have no liver nodules in ultrasound sonography and with normal AFP, but have increased levels of PIVKA-II and are further confirmed by CT/MRI. Obviously, PIVKA-II is very helpful for these patient population.

How has PIVKA-II aided in your clinical decision making?

PIVKA-II can help us to have one more useful tool for improving the early diagnosis of liver cancers.

The views and opinions expressed by Prof. Ming-Lung Yu are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.

Dr Bao Toan Nguyen describes how PIVKA-II is used in MEDIC-LAB for HCC detection

Interview transcript:

Introduction

My name is Bao Toan Nguyen, Lab Manager at MEDIC Center in Ho Chi Minh City, Vietnam. I have worked at MEDIC since 1999. I have been focusing on immunoassay, infectious disease, cancer, lab automation system, and lab quality. Lately, I am very interested in research that investigates biomarkers in early detection of HCC.

Tell us about MEDIC-LAB

MEDIC was established in 1990 in Ho Chi Minh City and is the first private and largest laboratory in South Vietnam. In 2007 we acquired ISO 9000 and in 2017 we acquired ISO 15189.

Why was PIVKA-II implemented in your lab? What was the clinician’s unmet need?

HCC is the most common cancer among all cancers in Vietnam. Unfortunately, about 65% newly diagnosed HCC cases are diagnosed at the advanced stage. Currently Vietnamese doctors are familiar with AFP and ultrasound for HCC surveillance, but AFP and ultrasound have limitations in HCC early detection. Therefore, more biomarkers are designed to increase the early detection rates. The new biomarker, PIVKA-II, has been introduced in Vietnam since 2015.

What’s your experience with PIVKA-II?

Using a combination of PIVKA II and AFP, overall sensitivity for HCC detection was 92% at the specificity of 82%. At MEDIC our clinical doctors combine PIVKA-II and AFP for HCC diagnosis and surveillance.

Patient cases

Clinical case 1:

Patient is a male, 44 years old. His HBV infection was more than ten years ago, no treatment. AFP is normal: 2.64 ng/mL, but PIVKA-II is so high: 217 ng/mL, and CT scan shows a 5 cm liver tumor.

Clinical case 2:

Patient is also a male, 56 years old, post-hepatectomy. From ultrasound conclusion, the patient has an HCC tumor. AFP is very low: 1.36 ng/mL, but PIVKA-II is very high: more than 23,000 ng/mL.

The views and opinions expressed by Dr. Bao Toan Nguyen are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.