Predicting Outcome of Transplant-Eligible Patients with Hepatocellular Carcinoma
Abstract
I am a clinical investigator focused on improving the lives of my patients with liver cancer. I am trained as a gastroenterologist and transplant hepatologist committed to improving the current diagnosis and treatment options for patients with hepatocellular carcinoma (HCC). I saw the unmet need in the lack of identifiable markers that can distinguish patients who have rapidly progressing HCC vs. slow growing disease. This is critical in patients with early stage HCC who are predominantly on the liver transplantation waiting list as a curative treatment and wait over a year; unfortunately, 15%-30% of them are eliminated from the list with progression of HCC, outside the transplant criteria after months of waiting. This served as my impetus to develop a multifocal prognostic model for early-stage HCC with the goal to develop effective individualized treatment plans for patients with HCC. This Peer Reviewed Cancer Research Program Career Development Award will facilitate the realization of my goal by allowing funding that is needed to examine the impact of novel image-based and blood-based biomarkers and personalized medical history on HCC progression over time. The overarching goal of this study is to develop new tools to predict cancer progression in patients with HCC and advanced liver disease. This study will enroll patients with HCC who are currently listed for liver transplantation. In addition to blood samples to analyze the detection of cancer components – circulating tumor cells or circuiting tumor DNA, their magnetic resonance imaging and computerized tomography images will be analyzed to obtain 3D tumor volume (vs. standard 2D dimensions) and advanced tumor characterization. Patients will be followed until the time of their liver transplantation (approximately 1-1.5 years) or until they are considered not a transplant candidate due to cancer progression. Outcome data will be collected during this 3-year award period. We are particularly well positioned to undertake this research. Our center is one of the largest liver transplant centers in the region, managing a large population of patients with HCC. We have an exceptional multidisciplinary team that has worked together both clinically and scientifically. We already have a serum/plasma biorepository linked to clinical data from more than 300 patients with HCC with matching explant tumor specimens, a biobank that this project will expand. This proposal has the potential to establish a new prognostic algorithm that can be personalized to patients with early stage HCC. By combining patient-specific medical data with new imaging and genomic information, we can better define the natural history of their HCC. This is especially relevant within the US military community, where major risk factors for HCC are over-represented including hepatitis B and C infections, obesity, diabetes and hyperlipidemia, and male gender. It would help to identify patients who can benefit from targeted neo-adjuvant treatment before deterioration of liver function precludes further HCC interventions. This tailored approach would also improve liver transplant organ allocation—a vital, scarce resource—thus improving overall therapeutic value for liver transplant recipients.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010605
Entities
People
- Amy Kim
Organizations
- Johns Hopkins University
- United States Army