The European Association for the Study of the Liver (EASL) and the European Organisation for Research and Treatment of Cancer (EORTC) today publish their first joint Clinical Practice Guidelines (CPGs) on the management of hepatocellular carcinoma (HCC).(1) The EASL-EORTC guidelines define the use of surveillance, diagnosis and therapeutic strategies recommended for patients with HCC.
HCC is the most common form of liver cancer, representing more than 90% of primary liver cancers and an increasing global health burden. It is estimated that, by 2020, the number of cases will reach 78,000 in Europe (up from 65,000 in 2008) and 27,000 in the US (up from 21,000 in 2008). Affecting 2.4 times more men than women, approximately 90% of HCCs are associated with a known underlying risk factor -- the most frequent including chronic viral hepatitis (types B and C), alcohol intake and aflatoxin(2) exposure.
Lead author Professor Josep M Llovet said: "Despite the availability of effective surveillance and treatment strategies for HCC, the proportion of patients currently receiving these interventions is suboptimal. When considered in light of HCC's growing European and global incidence, it is critical that measures are implemented to increase access to surveillance, early diagnosis and effective treatment."
Based on a systematic review of existing literature, the CPGs provide best practice recommendations on a number of key areas:
- Epidemiology, risk factors and prevention
- Surveillance, including target populations
- Diagnosis, including non-invasive diagnosis, pathological diagnosis, molecular diagnosis and assessment of disease extension
- Staging systems, including the Barcelona-Clinic Liver Cancer (BCLC) classification (outcome prediction and treatment allocation) and molecular classification of HCC
- Surgical, loco-regional and medical treatment update, including latest advances and methods, and the endorsement of treatment stage migration
- Clinical trial design
- Assessment of response, and recommendation of the modified RECIST (mRECIST) criteria
The guidelines also identify major unmet needs for advancing HCC research and, ultimately, contributing to improved patient care, recommending physicians, investigators, health policy agencies, the pharmaceutical industry and care providers prioritise devoting future resources to:
- Evaluating adjuvant therapies after resection/local ablation and the benefits of combining molecular therapies with local ablation and loco-regional treatments
- Exploring downstaging(3) strategies to rescue patients with HCCs beyond conventional Milan criteria
- Developing effective treatment packages for advanced tumours and second-line therapies
- Robust cost-benefit and health-economic analysis/studies to facilitate clinical decision-making
- Providing adequate quality of life assessment tools, as quality of life is a relevant end-point for research studies
Professor Llovet said: "The HCC CPGs outline a clear need for investment in research, through which it will be possible to address important future clinical goals and advances, such as biobanking (the considered collection of tissue and serum samples in research studies) and personalised medicine."
Commenting on the CPGs, EASL Secretary General Professor Mark Thursz said: "EASL is dedicated to promoting hepatology research and education to improve the worldwide treatment of liver disease. As there have been several key clinical and scientific advances over the past decade, these guidelines update the recommendations reported by the EASL HCC panel of experts in 2001. EASL hopes these new HCC guidelines provide clinicians with the most up-to-date, evidence based methods for the management of affected patients."
To be simultaneously published in the Journal of Hepatology (Vol. 56 No. 4 April, 2012) and the European Journal of Cancer (Vol. 48 No. 5 April, 2012), the EASL-EORTC joint CPGs on the management of HCC will also be presented during a session of the International Liver CongressTM 2012 in Barcelona (1530, Saturday, April 21st).
EASL is the leading European scientific society involved in promoting research and education in hepatology. EASL attracts the foremost hepatology experts and has an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.
EASL's main focus on education and research is delivered through numerous events and initiatives, including:
- The International Liver CongressTM (http://www.
easl.) which is the main scientific and professional event in hepatology worldwide eu/ _the-international-liver-congress/ general-information
- Meetings including Monothematic and Special conferences, Post Graduate Courses and other endorsed meetings that take place throughout the year (http://www.
easl.) eu/ _events
- Clinical and Basic Schools of Hepatology, a series of events covering different aspects in the field of hepatology (http://www.
easl.) eu/ _education
- Journal of Hepatology, published monthly (http://www.
easl.) eu/ members/ journal-of-hepatology
- Participation in a number of policy initiatives at European level
About the EORTC
The EORTC is a unique organization - a vibrant example of the fact that science and research know no national boundaries. Established in 1962, the EORTC is a non-profit research organization operating as an international association under Belgian law.
The EORTC currently links a network of more than 2,500 pre-clinical scientists and oncologists in more than 300 hospitals in over 30 countries. It encompasses all aspects of cancer research, from translational research and new drug development to large phase III clinical trials and meta-analyses.
The 170 members of the EORTC Headquarters staff handle some 6,000 new patients enrolled each year in cancer clinical trials, approximately 30 protocols that are permanently open to patient entry, over 50,000 patients who are in follow-up, and a database of more than 180,000 patients.
The ultimate goal of the EORTC is to improve the future of cancer therapy by developing new agents and innovative approaches and to test more effective treatment strategies using commercially available drugs, or surgery and radiotherapy.
1. Llovet, J.M. et al (2012) EASL-EORTC Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. Available at http://www.
2. Aflatoxins are naturally occurring toxins produced by many species of the fungus Aspergillus and are among the most carcinogenic substances known. Dietary exposure to aflatoxin B1, derived from the fungi Aspergillus flavus and Aspergillus parasiticus, is an important co-factor for HCC development in parts of Africa and Asia. These moulds are ubiquitous in nature and contaminate a number of staple foodstuffs in tropical and subtropical regions.
3. Downstaging is a situation in which a patient with a previously unresectable tumour or large number of tumours becomes eligible for surgery (resection) or transplant after treatment.