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

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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.

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.