Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Key clinical point: Lenvatinib combined with transarterial chemoembolization (LEN-TACE) is more effective than LEN alone as the first-line therapy for advanced hepatocellular carcinoma (HCC).

Major finding: After a 17.0-month median follow-up, the LEN-TACE vs LEN group had a significantly longer median overall survival (17.8 vs 11.5 months; hazard ratio [HR] 0.45; P < .001) and progression-free survival (10.6 vs 6.4 months; HR 0.43; P < .001) and higher objective response rate (54.1% vs 25.0%; P < .001).

Study details: Findings are from a multicenter, phase 3 trial, LAUNCH, that included 338 adult patients with treatment-naive primary or initial recurrent advanced HCC after surgery who were randomly assigned to receive LEN-TACE (n = 170) or LEN monotherapy (n = 168).

Disclosures: This study was supported by Science and Technology Innovation 2030 Major Projects, China, among others. One author declared serving as a consultant/advisor for and receiving honoraria and research funding from GenomiCare.

Source: Peng Z et al. Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma: A phase III, randomized clinical trial (LAUNCH). J Clin Oncol. 2022 (Aug 3). Doi: 10.1200/JCO.22.00392

Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.

Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P  =  .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P  =  .701).

Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.

Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.

Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615

Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.

Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P  =  .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P  =  .701).

Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.

Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.

Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615

Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.

Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P  =  .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P  =  .701).

Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.

Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.

Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615

Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.

Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P  =  .036) and longer median progression-free survival (10.4 vs 6.3 months; P  =  .015) and overall survival (13.8 vs 8.8 months; P  =  .013), with 12 patients vs none experiencing successful downstaging.

Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).

Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.

Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi:  10.3390/cancers14153619

Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.

Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P  =  .036) and longer median progression-free survival (10.4 vs 6.3 months; P  =  .015) and overall survival (13.8 vs 8.8 months; P  =  .013), with 12 patients vs none experiencing successful downstaging.

Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).

Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.

Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi:  10.3390/cancers14153619

Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.

Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P  =  .036) and longer median progression-free survival (10.4 vs 6.3 months; P  =  .015) and overall survival (13.8 vs 8.8 months; P  =  .013), with 12 patients vs none experiencing successful downstaging.

Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).

Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.

Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi:  10.3390/cancers14153619

Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.

Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).

Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.

Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.

Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1

Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.

Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).

Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.

Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.

Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1

Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.

Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).

Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.

Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.

Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

Key clinical point: The combination of sorafenib adjuvant therapy and radiofrequency ablation (RFA) offers better survival outcomes than RFA alone in patients with recurrent hepatocellular carcinoma (RHCC) within Milan criteria after curative resection of primary HCC.

Major finding: Patients receiving RFA plus sorafenib vs RFA alone had significantly higher 1- and 3-year overall survival (97.7% vs 93.1%; P  =  .018 and 83.7% vs 61.3%; P < .001, respectively) and tumor-free survival (90.8% vs 67.8% and 49.0% vs 28.0%, respectively; both P < .001) rates.

Study details: This multicenter, retrospective study included 174 propensity score-matched pairs of adult patients with RHCC within Milan criteria who did or did not receive sorafenib after RFA.

Disclosures: This study was sponsored by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Zhou Q et al. Sorafenib as adjuvant therapy following radiofrequency ablation for recurrent hepatocellular carcinoma within Milan criteria: A multicenter analysis. J Gastroenterol. 2022 (Jul 11). Doi: 10.1007/s00535-022-01895-3

People are more likely to die of alcohol-associated liver disease (ALD) when there are fewer gastroenterologists in their state, researchers say.

The finding raises questions about steps that policymakers could take to increase the number of gastroenterologists and spread them more evenly around the United States.

“We found that there’s a fivefold difference in density of gastroenterologists through different states,” said Brian P. Lee, MD, MAS, an assistant professor of clinical medicine at the University of Southern California, Los Angeles.

Dr. Lee and colleagues published their findings in Clinical Gastroenterology and Hepatology.

ALD is becoming more common, and it is killing more people. Research among veterans has linked visits to gastroenterologists to a lower risk for death from liver disease.

To see whether that correlation applies more broadly, Dr. Lee and colleagues compared multiple datasets. One from the U.S. Health Resources & Service Administration provided the number of gastroenterologists per 100,000 population. The other from the U.S. Centers for Disease Control and Prevention provided ALD-related deaths per 1,000,000 adults for each state and the District of Columbia.

The researchers adjusted for many variables that could affect the relationship between the availability of gastroenterologists and deaths related to ALD, including the age distribution of the population in each state, the gender balance, race and ethnicity, binge drinking, household income, obesity, and the proportion of rural residents.

They found that for every additional gastroenterologist, there is almost one fewer ALD-related death each year per 100,000 population (9.0 [95% confidence interval, 1.3-16.7] fewer ALD-related deaths per 1,000,000 population for each additional gastroenterologist per 100,000 population).

The strength of the association appeared to plateau when there were at least 7.5 gastroenterologists per 100,000 people.

From these findings, the researchers calculated that as many as 40% of deaths from ALD nationwide could be prevented by providing more gastroenterologists in the places where they are lacking.

The mean number of gastroenterologists per 100,000 people in the United States was 4.6, and the annual ALD-related death rate was 85.6 per 1,000,000 people.

The Atlantic states had the greatest concentration of gastroenterologists and the lowest ALD-related mortality, whereas the Mountain states had the lowest concentration of gastroenterologists and the highest ALD-related mortality.

The lowest mortality related to ALD was in New Jersey, Maryland, and Hawaii, with 52 per 1,000,000 people, and the highest was in Wyoming, with 289.
 

Study shines spotlight on general GI care

Access to liver transplants did not make a statistically significant difference in mortality from ALD.

“It makes you realize that transplant will only be accessible for really just a small fraction of the population who needs it,” Dr. Lee told this news organization.

General gastroenterologic care appears to make a bigger difference in saving patients’ lives. “Are they getting endoscopy for bleeding from varices?” Dr. Lee asked. “Are they getting appropriate antibiotics prescribed to prevent bacterial infection of ascites?”

The concentration of primary care physicians did not reduce mortality from ALD, and neither did the concentration of substance use, behavioral disorder, and mental health counselors.

Previous research has shown that substance abuse therapy is effective. But many people do not want to undertake it, or they face barriers of transportation, language, or insurance, said Dr. Lee.

“I have many patients whose insurance will provide them access to medical visits to me but will not to substance-use rehab, for example,” he said.

To see whether the effect was more generally due to the concentration of medical specialists, the researchers examined the state-level density of ophthalmologists and dermatologists. They found no significant difference in ALD-related mortality.

The finding builds on reports by the American Gastroenterological Association and the American Association for the Study of Liver Diseases that the number of gastroenterologists has not kept up with the U.S. population nor the burden of digestive diseases, and that predicts a critical shortage in the future.
 

Overcoming barriers to care for liver disease

The overall supply of gastroenterologists could be increased by reducing the educational requirements and increasing the funding for fellowships, said Dr. Lee.

“We have to have a better understanding as to the barriers to gastroenterology practice in certain areas, then interventions to address those barriers and also incentives to attract gastroenterologists to those areas,” Dr. Lee said.

The study underscores the importance of access to gastroenterological care, said George Cholankeril, MD, assistant professor of medicine at Baylor College of Medicine, Houston, who was not involved in the study. That urgency has only grown as ALD has spiraled up with the COVID-19 pandemic, he said.

“Anyone in clinical practice right now will be able to say that there’s been a clear rising tide of patients with alcohol-related liver disease,” he told this news organization. “There’s an urgent need to address this and provide the necessary resources.”

Prevention remains essential, Dr. Cholankeril said.

Gastroenterologists and primary care physicians can help stem the tide of ALD by screening their patients for the disease through a tool like AUDIT (Alcohol Use Disorders Identification Test), he said. They can then refer patients to substance abuse treatment centers or to psychologists and psychiatrists.

Dr. Lee and Dr. Cholankeril report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

People are more likely to die of alcohol-associated liver disease (ALD) when there are fewer gastroenterologists in their state, researchers say.

The finding raises questions about steps that policymakers could take to increase the number of gastroenterologists and spread them more evenly around the United States.

“We found that there’s a fivefold difference in density of gastroenterologists through different states,” said Brian P. Lee, MD, MAS, an assistant professor of clinical medicine at the University of Southern California, Los Angeles.

Dr. Lee and colleagues published their findings in Clinical Gastroenterology and Hepatology.

ALD is becoming more common, and it is killing more people. Research among veterans has linked visits to gastroenterologists to a lower risk for death from liver disease.

To see whether that correlation applies more broadly, Dr. Lee and colleagues compared multiple datasets. One from the U.S. Health Resources & Service Administration provided the number of gastroenterologists per 100,000 population. The other from the U.S. Centers for Disease Control and Prevention provided ALD-related deaths per 1,000,000 adults for each state and the District of Columbia.

The researchers adjusted for many variables that could affect the relationship between the availability of gastroenterologists and deaths related to ALD, including the age distribution of the population in each state, the gender balance, race and ethnicity, binge drinking, household income, obesity, and the proportion of rural residents.

They found that for every additional gastroenterologist, there is almost one fewer ALD-related death each year per 100,000 population (9.0 [95% confidence interval, 1.3-16.7] fewer ALD-related deaths per 1,000,000 population for each additional gastroenterologist per 100,000 population).

The strength of the association appeared to plateau when there were at least 7.5 gastroenterologists per 100,000 people.

From these findings, the researchers calculated that as many as 40% of deaths from ALD nationwide could be prevented by providing more gastroenterologists in the places where they are lacking.

The mean number of gastroenterologists per 100,000 people in the United States was 4.6, and the annual ALD-related death rate was 85.6 per 1,000,000 people.

The Atlantic states had the greatest concentration of gastroenterologists and the lowest ALD-related mortality, whereas the Mountain states had the lowest concentration of gastroenterologists and the highest ALD-related mortality.

The lowest mortality related to ALD was in New Jersey, Maryland, and Hawaii, with 52 per 1,000,000 people, and the highest was in Wyoming, with 289.
 

Study shines spotlight on general GI care

Access to liver transplants did not make a statistically significant difference in mortality from ALD.

“It makes you realize that transplant will only be accessible for really just a small fraction of the population who needs it,” Dr. Lee told this news organization.

General gastroenterologic care appears to make a bigger difference in saving patients’ lives. “Are they getting endoscopy for bleeding from varices?” Dr. Lee asked. “Are they getting appropriate antibiotics prescribed to prevent bacterial infection of ascites?”

The concentration of primary care physicians did not reduce mortality from ALD, and neither did the concentration of substance use, behavioral disorder, and mental health counselors.

Previous research has shown that substance abuse therapy is effective. But many people do not want to undertake it, or they face barriers of transportation, language, or insurance, said Dr. Lee.

“I have many patients whose insurance will provide them access to medical visits to me but will not to substance-use rehab, for example,” he said.

To see whether the effect was more generally due to the concentration of medical specialists, the researchers examined the state-level density of ophthalmologists and dermatologists. They found no significant difference in ALD-related mortality.

The finding builds on reports by the American Gastroenterological Association and the American Association for the Study of Liver Diseases that the number of gastroenterologists has not kept up with the U.S. population nor the burden of digestive diseases, and that predicts a critical shortage in the future.
 

Overcoming barriers to care for liver disease

The overall supply of gastroenterologists could be increased by reducing the educational requirements and increasing the funding for fellowships, said Dr. Lee.

“We have to have a better understanding as to the barriers to gastroenterology practice in certain areas, then interventions to address those barriers and also incentives to attract gastroenterologists to those areas,” Dr. Lee said.

The study underscores the importance of access to gastroenterological care, said George Cholankeril, MD, assistant professor of medicine at Baylor College of Medicine, Houston, who was not involved in the study. That urgency has only grown as ALD has spiraled up with the COVID-19 pandemic, he said.

“Anyone in clinical practice right now will be able to say that there’s been a clear rising tide of patients with alcohol-related liver disease,” he told this news organization. “There’s an urgent need to address this and provide the necessary resources.”

Prevention remains essential, Dr. Cholankeril said.

Gastroenterologists and primary care physicians can help stem the tide of ALD by screening their patients for the disease through a tool like AUDIT (Alcohol Use Disorders Identification Test), he said. They can then refer patients to substance abuse treatment centers or to psychologists and psychiatrists.

Dr. Lee and Dr. Cholankeril report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

People are more likely to die of alcohol-associated liver disease (ALD) when there are fewer gastroenterologists in their state, researchers say.

The finding raises questions about steps that policymakers could take to increase the number of gastroenterologists and spread them more evenly around the United States.

“We found that there’s a fivefold difference in density of gastroenterologists through different states,” said Brian P. Lee, MD, MAS, an assistant professor of clinical medicine at the University of Southern California, Los Angeles.

Dr. Lee and colleagues published their findings in Clinical Gastroenterology and Hepatology.

ALD is becoming more common, and it is killing more people. Research among veterans has linked visits to gastroenterologists to a lower risk for death from liver disease.

To see whether that correlation applies more broadly, Dr. Lee and colleagues compared multiple datasets. One from the U.S. Health Resources & Service Administration provided the number of gastroenterologists per 100,000 population. The other from the U.S. Centers for Disease Control and Prevention provided ALD-related deaths per 1,000,000 adults for each state and the District of Columbia.

The researchers adjusted for many variables that could affect the relationship between the availability of gastroenterologists and deaths related to ALD, including the age distribution of the population in each state, the gender balance, race and ethnicity, binge drinking, household income, obesity, and the proportion of rural residents.

They found that for every additional gastroenterologist, there is almost one fewer ALD-related death each year per 100,000 population (9.0 [95% confidence interval, 1.3-16.7] fewer ALD-related deaths per 1,000,000 population for each additional gastroenterologist per 100,000 population).

The strength of the association appeared to plateau when there were at least 7.5 gastroenterologists per 100,000 people.

From these findings, the researchers calculated that as many as 40% of deaths from ALD nationwide could be prevented by providing more gastroenterologists in the places where they are lacking.

The mean number of gastroenterologists per 100,000 people in the United States was 4.6, and the annual ALD-related death rate was 85.6 per 1,000,000 people.

The Atlantic states had the greatest concentration of gastroenterologists and the lowest ALD-related mortality, whereas the Mountain states had the lowest concentration of gastroenterologists and the highest ALD-related mortality.

The lowest mortality related to ALD was in New Jersey, Maryland, and Hawaii, with 52 per 1,000,000 people, and the highest was in Wyoming, with 289.
 

Study shines spotlight on general GI care

Access to liver transplants did not make a statistically significant difference in mortality from ALD.

“It makes you realize that transplant will only be accessible for really just a small fraction of the population who needs it,” Dr. Lee told this news organization.

General gastroenterologic care appears to make a bigger difference in saving patients’ lives. “Are they getting endoscopy for bleeding from varices?” Dr. Lee asked. “Are they getting appropriate antibiotics prescribed to prevent bacterial infection of ascites?”

The concentration of primary care physicians did not reduce mortality from ALD, and neither did the concentration of substance use, behavioral disorder, and mental health counselors.

Previous research has shown that substance abuse therapy is effective. But many people do not want to undertake it, or they face barriers of transportation, language, or insurance, said Dr. Lee.

“I have many patients whose insurance will provide them access to medical visits to me but will not to substance-use rehab, for example,” he said.

To see whether the effect was more generally due to the concentration of medical specialists, the researchers examined the state-level density of ophthalmologists and dermatologists. They found no significant difference in ALD-related mortality.

The finding builds on reports by the American Gastroenterological Association and the American Association for the Study of Liver Diseases that the number of gastroenterologists has not kept up with the U.S. population nor the burden of digestive diseases, and that predicts a critical shortage in the future.
 

Overcoming barriers to care for liver disease

The overall supply of gastroenterologists could be increased by reducing the educational requirements and increasing the funding for fellowships, said Dr. Lee.

“We have to have a better understanding as to the barriers to gastroenterology practice in certain areas, then interventions to address those barriers and also incentives to attract gastroenterologists to those areas,” Dr. Lee said.

The study underscores the importance of access to gastroenterological care, said George Cholankeril, MD, assistant professor of medicine at Baylor College of Medicine, Houston, who was not involved in the study. That urgency has only grown as ALD has spiraled up with the COVID-19 pandemic, he said.

“Anyone in clinical practice right now will be able to say that there’s been a clear rising tide of patients with alcohol-related liver disease,” he told this news organization. “There’s an urgent need to address this and provide the necessary resources.”

Prevention remains essential, Dr. Cholankeril said.

Gastroenterologists and primary care physicians can help stem the tide of ALD by screening their patients for the disease through a tool like AUDIT (Alcohol Use Disorders Identification Test), he said. They can then refer patients to substance abuse treatment centers or to psychologists and psychiatrists.

Dr. Lee and Dr. Cholankeril report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Baseline hepatitis B virus (HBV) DNA levels are not associated with the clinical outcomes of patients with HBV-related hepatocellular carcinoma (HCC) treated with anti-programmed cell death protein 1 (anti-PD-1)-based immunotherapy.

Major finding: Baseline HBV DNA levels were not significantly associated with the overall survival (adjusted hazard ratio [aHR] 0.77; P  =  .59) or progression-free survival (aHR 0.68; P  =  .098).

Study details: This single-center retrospective observational study included 217 patients with advanced HBV-related HCC who received ≥1 dose of anti-PD-1 therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China and Medical Science and Technology Research Project of Health Commission of Henan Province. The authors declared no conflicts of interest.

Source: An M et al. Association of hepatitis B virus DNA levels with overall survival for advanced hepatitis B virus-related hepatocellular carcinoma under immune checkpoint inhibitor therapy. Cancer Immunol Immunother. 2022 (Jul 30). Doi: 10.1007/s00262-022-03254-w

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Compared with transcatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) offers better efficacy in patients with advanced hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without significantly compromising safety.

Major finding: Patients receiving HAIC vs TACE had a significantly longer median overall survival (11.2 vs 9.0 months; P  =  .010) and progression-free survival (5.6 vs 2.0 months; P  =  .006) and a higher objective response rate (56.8% vs 18.2%; P < .001). No treatment‐related grade 4/5 adverse events were reported.

Study details: This was a propensity score‐matched cohort study including 44 pairs of adult patients with advanced HCC and PVTT who underwent HAIC with oxaliplatin plus raltitrexed or TACE.

Disclosures: This study was supported by the Guiding Project of Science and Technology Program of Fujian Province, China.

Source: Chen S, Yuan B, et al. Hepatic arterial infusion oxaliplatin plus raltitrexed and chemoembolization in hepatocellular carcinoma with portal vein invasion: A propensity score-matching cohort study. J Surg Oncol. 2022 (Jul 20). Doi: 10.1002/jso.27023

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511

Key clinical point: Heavy alcohol intake and ALDH2 rs671 polymorphism are associated with a significantly increased risk for hepatocellular carcinoma (HCC) development in patients with hepatitis B virus (HBV)-related cirrhosis.

Major finding: Alcohol intake amount (>160 vs 80-160 g/day: adjusted hazard ratio [aHR] 1.78; P  =  .04) and ALDH2 rs671 polymorphism (GA/AA vs GG genotype: aHR 5.61; P < .001) were significantly associated with an increased incidence of HCC.

Study details: This retrospective cohort study enrolled 1515 patients with cirrhosis due to heavy alcoholism or HBV infection.

Disclosures: This study was sponsored by the Ministry of Science and Technology, Taiwan, E-Da Hospital-National Taiwan University Hospital Joint Research Program, and others.

Source: Tsai MC et al. Association of heavy alcohol intake and ALDH2 rs671 polymorphism with hepatocellular carcinoma and mortality in patients with hepatitis B virus–related cirrhosis. JAMA Netw Open. 2022;5(7):e2223511 (Jul 25). Doi: 10.1001/jamanetworkopen.2022.23511