Steven Lidofsky, MD, PhD
Hepatocellular carcinoma (HCC), the most common type of liver cancer, is the sixth leading cause of cancer-related death in the United States and the third worldwide. Unlike many cancers, the risk groups (cirrhosis and longstanding hepatitis B infection) are well defined. When HCC is detected prior to symptom onset, curative treatment and prolonged survival are possible. In contrast, the prognosis for a patient diagnosed with symptomatic HCC is poor with limited survival.
Current screening methods for HCC involve frequent surveillance with ultrasound. While this screening method is effective, reducing tumor burden and increasing survival times, fewer than one in three at-risk individuals undergo appropriate ultrasound monitoring, in part due to logistical barriers associated with access. These challenges are exacerbated in rural regions, like Vermont, leading to even fewer at-risk individuals receiving potentially life-saving monitoring.
The need for alternative screening methods for HCC has led to the development of the ALTUS trial, an international multicenter study, which will use a blood-based assay (“liquid biopsy”) to screen for HCC. The blood-based assay screens for the presence of protein biomarkers and selected methylated DNAs associated with tumor development. The study will compare the performance of the blood-based assay to the use of ultrasound for HCC detection.
The ALTUS study is opening at the University of Vermont Medical Center, where lead investigators Steven Lidofsky, MD, PhD, and Nicholas Ferrentino, MD, plan to recruit at least four participants aged 55 and older with cirrhosis. A total of 2,500 people will be recruited to participate in the trial worldwide. If the liquid biopsy assay performs similarly to ultrasound in detecting cancer, it would revolutionize HCC screening, making it easier for patients to access appropriate monitoring. This would allow patients to only have to make visits for liver imaging for diagnostic confirmation and disease staging. This paradigm shift in screening would greatly benefit Vermont residents and substantially increase screening accessibility.