CSIR’s Updates on Liver Cancer Research January 2024

In January 2024, the Central Drug Research Institute in India, in collaboration with CIMAP, CBMR, and CSIR-CDRI, conducted a significant study shedding light on liver cancer. The focus was on hepatocellular carcinoma (HCC), the most common form of liver cancer. The study highlighted metabolic changes in cancer cells, suggesting potential avenues for prevention and diagnosis.

Led by Dr. Madhav Nilakanth Mugale of CSIR-CDRI, the study utilized an animal model to mimic the development of human HCC. It identified specific alterations associated with HCC progression, including changes in body mass, increased serum enzyme levels, and modifications in hepatic architecture. Published in Elsevier, this research opens doors for targeted therapies based on metabolic reprogramming.

Additionally, a February 2024 update highlighted the link between liver cancer and type 2 diabetes. Nonalcoholic fatty liver disease (NAFLD) often observed in individuals with type 2 diabetes can lead to liver inflammation, cirrhosis, and increased cancer risk. A study from Stanford Medicine proposed using a measurable biophysical characteristic to identify type 2 diabetics at higher risk of liver cancer, even if they don’t meet current screening criteria.

The implications are significant: current screening primarily targets individuals with cirrhosis, leaving out many high-risk individuals, especially those with type 2 diabetes. Reevaluating screening protocols to include diabetic patients could lead to earlier detection and improved outcomes. Furthermore, this research may influence screening strategies for other diabetes-related cancers like breast cancer.

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Liver Cancer Risks and Diabetes

People with type 2 diabetes often struggle with excess fat production due to their liver’s inability to effectively regulate blood sugar levels. This condition, known as nonalcoholic fatty liver disease (NAFLD), can lead to liver inflammation, scarring, and eventually cirrhosis. Notably, individuals with type 2 diabetes face a significantly higher risk of developing liver cancer compared to those without diabetes.

A recent study from Stanford Medicine, conducted in February 2024, proposes a new approach to identifying type 2 diabetics at elevated risk of liver cancer who may not meet current screening criteria. Traditionally, liver cancer screening has focused primarily on individuals with cirrhosis, leaving out many high-risk individuals, particularly those with type 2 diabetes who may not yet have developed cirrhosis.

The implications of this study suggest a need for reevaluation of liver cancer screening protocols to include patients with diabetes. By expanding screening criteria, earlier detection of liver cancer could be achieved, leading to improved outcomes. Furthermore, this research may influence screening strategies for other diabetes-related cancers, such as breast cancer, highlighting the broader significance of early detection efforts in diabetes management.

Recent Therapy Advances

In recent years, significant advancements have emerged in cancer therapeutics, particularly concerning liver cancers. Major players in the field are actively researching and developing innovative treatment approaches through clinical trials and the creation of advanced therapies.

For example:

  • In March 2024, Terumo, a Japan-based company, introduced B-TACE (Balloon-TACE), an advanced therapy designed for liver cancer management. Terumo’s B-TACE device, Occlusafe, facilitates the precise delivery of chemotherapy drugs to the tumor, minimizing damage to surrounding healthy tissues.
  • In February 2024, Biosyngen’s BST02 received Fast Track Designation (FTD) from the US FDA, covering the treatment of various liver cancer forms, including cholangiocarcinoma and hepatocellular carcinoma.
  • In January 2024, AstraZeneca’s EMERALD-1 Phase III trial reported positive outcomes. It showed that combining Imfinzi (durvalumab) with TACE and bevacizumab significantly improved progression-free survival (PFS) among hepatocellular carcinoma (HCC) patients eligible for embolization, compared to TACE alone.
  • In November 2023, Terumo also launched B-TACE for liver cancer management, emphasizing its precision and reduced harm to healthy tissues.
Targeted Therapy for Hepatocellular Carcinoma

Hepatocellular Carcinoma (HCC) stands out as the most prevalent form of primary liver cancer, accounting for 90% of all reported cases. Despite constituting only 3% of 5-year survival rates, it ranks third in cancer-related mortality. While systemic therapy has shown some clinical improvements in advanced stages, the prognosis remains grim. The emergence of novel molecular-targeted medications in recent decades has shown promising results in clinical trials. However, there’s a pressing need for further research into new treatments given the limited benefits and poor prognoses associated with current systemic therapy. This underscores the importance of targeted and advanced therapies.

The landscape of HCC treatment has undergone significant transformation over the past 16 years, primarily due to major advancements in targeted therapy. Key factors driving this evolution include:

  1. Introduction of Sorafenib (2007): Sorafenib, the first effective and approved targeted therapy for advanced HCC, marked a pivotal moment in liver cancer treatment. Its success paved the way for further therapeutic developments.
  2. Emerging Treatment Options: New targeted drugs like Lenvatinib and the combination of Bevacizumab and Atezolizumab have emerged as viable first-line treatment options for advanced HCC patients, building on the efficacy of Sorafenib. Additionally, the introduction of Ramucirumab, Regorafenib, and Cabozantinib (specifically for patients with AFP > 400 ng/mL) has significantly broadened the therapeutic arsenal available for patients undergoing second-line treatment.

These advancements have provided patients with advanced HCC with improved treatment outcomes and a more optimistic prognosis.

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