Editor's Note:The 9th Congress of the Chinese Chapter of the International Hepato-Pancreato-Biliary Association (CCIHPBA) was held in Wuhan. The conference attracted more than 50 internationally renowned experts and scholars from over 20 countries including the United States, Germany, France, Russia, and Australia, as well as 21 academicians from the two academies and over 700 domestic experts in the field of hepato-pancreato-biliary. At this conference, Professor Eduard Jonas from the Groote Schuur Hospital, University of Cape Town, and President of the Europe-Africa Hepato-Pancreato-Biliary Association (E-AHPBA), delivered a wonderful report titled "Transitioning from guidelines to personalized medicine in the treatment of hepatocellular carcinoma - a global perspective." we invited Professor Eduard Jonas for an in-depth interview to share fascinating insights on the personalized treatment of liver cancer with colleagues in the field.

 

Q1:  At this conference, you delivered a report on the topic “Transitioning from guidelines to personalized medicine in the treatment of hepatocellular carcinoma – a global perspective” Could you share the key points of this presentation with our readers?

Prof. Eduard Jonas: Thank you very much for the question. So, we basically still apply the same guideline that was first published in 1999, in many forms present in national or regional hepatocellular carcinoma (HCC) management guidelines in the world. Those are still based on tumor characteristics, in other words, the size of the tumor and the number of the tumors in patients with HCC. Since then, there’s been a lot of development in looking at other prognostic factors, which includes the whole spectrum of omics research, where they’ve even identified some markers that will tell us more, give us more information than just the size and the number of the tumors. Unfortunately, these tests are still very complex and probably too complex to include it in the guidelines. So, there’s really a paucity of data in the clinical field related to the amount of research that has been done in the field of multi-omics.

Q2: In your region of Africa, how do the guidelines for the diagnosis and treatments of hepatocellular carcinoma differ from those in other parts of the world, particularly in Western and Asian countries?

Prof. Eduard Jonas: The problem is that there are some indications that we are dealing with a different disease in Africa, especially in sub-Saharan Africa, where the disease is driven by chronic hepatitis B infection. We see a lot of tumors in very young people, with very advanced tumors, and also in patients without cirrhosis of the liver. And that is the problem. Unfortunately, even if we follow the guidelines, in many countries, the treatments that are advised in the current guidelines are not available, and that really presents a major challenge for managing this disease.

Q3: How do you assess the current application of personalized treatment for hepatocellular carcinoma? In clinical practice, which patient characteristics or test results might be used to appropriately tailor treatment plans?

Prof. Eduard Jonas: As I’ve said, the wealth of research that has been done in the field of multi-omics, where different characteristics on a genetic or a cellular level have been identified that can predict prognosis, very few of these have actually resulted in any clinically usable information. And even if we look at alpha-fetoprotein, a very old marker that has been around for many, many years. We know it has got predictive characteristics in terms of survival but it is still for may reasons quite poorly integrated into the guidelines.

Prof. Eduard Jonas: I think there’s no doubt in my mind that the key to advances in managing HCC is really in systemic therapies. I think in terms of surgery, we have basically come to the limit in terms of liver resection and liver transplantation where the whole diseased liver with a tumor is removed. I think further advances really are going to be or need to be in the field of systemic therapies, where disease outside the liver is addressed sufficiently. And I will go as far as to say I think this battle will only be won when surgery is not a primary treatment, but it becomes an adjuvant or a neoadjuvant treatment to effective systemic therapies that will be the key to treat these patients successfully.