While more presentations at HepDART 2007, held December 9 to December 13 in Maui, Hawaii (and currently the only drug development conference for viral hepatitis), focused on HCV than HBV, the Hepatitis B Foundation (HBF) had its say at the meeting. HBF president Timothy Block, Ph.D., and Harvey Alter, M.D., chief of the infectious disease section in the Department of Transfusion Medicine at the National Institutes of Health, cochaired an HBF-sponsored symposium on liver cancer.
The HBF symposium, titled “Early Detection and Management of Cirrhosis and Hepatocellular Carcinoma,” focused on better ways to detect cirrhosis and liver cancer, including alternatives to a liver biopsy.
“The reason we worry about chronic HBV and HCV infections is because they can lead to progressive liver scarring and fibrosis, which in turn can lead to cirrhosis and liver cancer (hepatocellular carcinoma, or HCC),” said Adrian Di Bisceglie, M.D., chief of Hepatology at Saint Louis University School of Medicine.
HCC, the fastest rising cancer in the U.S. and other Western countries, is difficult to treat effectively because it tends to be discovered in an advanced stage. This makes early diagnosis crucial.
“If we can find the tumor when it’s small, we now have effective treatments, such as resection, transplantation and various forms of tumor ablation,” said Di Bisceglie.
At the symposium, Di Bisceglie spoke about HCC screening guidelines. The American Association for the Study of Liver Disease publishes guidelines for determining who is at risk for developing liver cancer and should be screened. Among those who have HBV, screening for cancer is recommended for Asian males over 40, females over 50, everyone with HBV and cirrhosis, a family history of HCC, those born in Africa now over age 20 and those who have active liver disease and evidence of inflammation.
According to Di Bisceglie, liver cancer in Japan has been rising for about two decades, and is thought to stem from HCV spreading through the population earlier than it did in the U.S. The Japanese, he said, rely more on tests for biomarkers in the blood to detect cancer early. This was confirmed by Masao Omata, M.D., the University of Tokyo, who discussed the Japanese experience over the past decade in treating HCC.
Speakers also addressed liver fibrosis, and the use of liver biopsy to measure it. Biopsy is uncomfortable, and many physicians and researchers are searching for alternatives such as serum biomarkers and other noninvasive tests.
One such method, called Fibroscan, involves a machine to send a “shock wave” through the liver, subsequently measuring its “wobble,” Di Bisceglie explained. The more fibrotic the liver, the less it wobbles. Speaker Thierry Poynard, M.D., Groupe Hospitalier Pitie-Salpetriere in France, has patented a set of blood tests to measure several markers that when plugged into an algorithm may provide an estimate of the amount of fibrosis. However, many believe that such tests are still years away from replacing biopsy.
“It was a lively session and very positive, and gave the clinicians a lot to think about,” Di Bisceglie said of the HBF symposium. “There are things that are coming that will change the ways we practice medicine.”
Steve Benowitz, science writer, Philadelphia, PA
