Liver cancer

This transcript was generated using an AI-based transcription tool and may contain errors. It reflects the spoken content of the recorded session and has been formatted for clarity.

Do you see an increase in liver tests due to increasing awareness?

Prof. Dr. med. Julia-Stefanie Frick: We see that our clinicians are mainly requesting conventional liver disease markers such as ALT or AST. But I think this emerging topic of chronic liver disease has not yet become part of their daily routine.

PD Dr. Nils Stührwohldt: We perform approximately 500,000 measurements each week, and of course, this includes many liver parameters. However, FIB-4 can currently also be calculated manually, but no one is asking for it because I do not think there has been enough focus on these algorithms among GPs so far. So, I think we have a stable number of parameters that we measure, and now we are adding digital biomarkers to these existing biomarkers.

Do you see an increase in demand for liver scores due to increasing awareness?

PD Dr. Nils Stührwohldt: So we are shifting our focus towards a more consultative role. These parameters, these digital biomarkers, can help us analyze data. So this is a kind of clinical decision support that we provide to our GPs and patients. And I think this requires a change in mindset.

Prof. Dr. med. Julia-Stefanie Frick: Our role is mainly to proactively inform our clinicians about the possibility of working with IVD-certified scores. They need to be aware that they have the option to use those scores, and we have to show them the value these scores provide for them and for their patients. Because I think there is a lack of information among the clinicians who are really doing the day-to-day work with patients. They need to be trained so that they can use those scores and feel confident using them. They also need to be able to work with the values they receive from us. And they need to understand what those values mean. They need to know how to use those values in the patient journey that follows laboratory diagnostics.

What is your lab’s role to deal with this healthcare burden?

Prof. Dr. med. Julia-Stefanie Frick: Well, you know, an IVD-certified score is a score that gives us a high level of confidence. It is validated, it is safe, and it is measured everywhere in the world using the same method. So you can compare the results. And this is a very good basis for ensuring that a patient receives the best possible medical care. This is not a value that is open to interpretation. Rather, it gives us something on which we can build the patient journey and determine the initial therapy a patient may need.

PD Dr. Nils Stührwohldt: As a lab, we focus on automated solutions, and now we are combining them with digitalization. And the process we are establishing is very simple. GPs only need three clicks to order an ADAPT score. We print the barcodes directly. They can send the sample to us. And when the samples arrive in our lab, we immediately measure the individual parameters. We calculate the scores and send back the results for both the parameters and the digital biomarker.

What would be the reasons why clinicians should use FIB-4 and ADAPT scores?

Prof. Dr. med. Julia-Stefanie Frick: If you do not do it automatically, there is usually a risk of incorrect calculations, for example. And this is something we can eliminate entirely. You also have to ensure that you are always using the most recently published calculation. This is something we can ensure because we have IVD certification. And processes performed manually are always more complicated because people can make mistakes. They take more time. They create more costs. And this is not the case when the process is automated. With one measurement, it is simply done.

PD Dr. Nils Stührwohldt: It is very simple for the MTLAs and very simple for the GPs. And it helps because normally they have to analyze the individual parameters. They have to put them into context. And in the end, if you do this manually, you can make mistakes. The next step is clinical decision support. We provide a score to GPs and patients. And a score really helps. A score immediately shows whether there is a risk or no risk. And this helps both GPs and patients. So I think this clinical decision support is truly a step forward towards better medicine.

What is the advantage for you as a lab to offer those tests?

Prof. Dr. med. Julia-Stefanie Frick: Of course, there are advantages for the lab, which can offer these solutions to its customers. This probably makes the lab more attractive. And it gives you the opportunity to offer more than just laboratory medicine to your customers, as well as the possibility of helping them take good care of their patients. But for me personally, what we are doing is fulfilling our responsibility towards patients, because these scores help us identify chronic liver diseases that are associated with a reduced life expectancy or a reduced quality of life. And if we can prevent this, we are doing what we are meant to do as medical doctors. We take care of our patients.

What are the advantages in the context of early detection?

PD Dr. Nils Stührwohldt: I think we are always focusing on people who are already ill. When do you go to a doctor? When you feel ill. However, we need to change this mindset. We have to focus on prevention. Prevention helps people stay healthy for longer. At the beginning, you measure FIB-4. You screen for patients who have elevated FIB-4 scores. Then you can measure ADAPT. At the end of the journey, you may use the GAAD score. This is a journey through the healthcare system. These scores help guide people from the GP to the specialist. It's very simple.

Doing now what patients need next - Roche

This transcript was generated using an AI-based transcription tool and may contain errors. It reflects the spoken content of the recorded session and has been formatted for clarity.

What is metabolic liver disease?

Prof. Dr. Jörn Schattenberg: Metabolic liver diseases are among the most common today. There was a change in nomenclature a couple of years ago. Today, we refer to the disease as metabolic dysfunction-associated steatotic liver disease, or MASLD. This represented a very important shift away from the previous terminology, in which the disease was described as non-alcoholic. “Non-alcoholic” had a negative connotation and was a negative definition. So defining the disease based on its pathophysiology was a major step forward. And I think this also helps to raise awareness of the disease. Because we are now defining the disease based on its mechanism: metabolic dysfunction leads to hepatic steatosis and then to fibrosis. This is all situated within the broader category of steatotic liver disease, which is the overarching term.

Why is it important to raise awareness about MASLD?

Prof. Dr. Jörn Schattenberg: MASLD is highly prevalent but frequently overlooked. Many patients, and even their physicians, are unaware that the patient has chronic liver disease. The disease does not cause obvious symptoms. The liver is located in the upper-right part of the body, and it is difficult to examine externally by touch or visual inspection. We need ultrasound-based technologies or blood-based biomarkers to assess the liver.

What is the diagnostic workup for patients?

Prof. Dr. Jörn Schattenberg: To identify MASLD today, we primarily use risk factors associated with the disease. These include obesity, type 2 diabetes, arterial hypertension, and hyperlipidemia. Family history is also a major risk factor. And this helps us in clinical practice to identify the patients who should undergo testing to detect advanced liver disease. Many patients are affected by fat accumulation in the liver, or MASLD, but only a few have very advanced disease. The challenge in this field is to identify the subgroup that would benefit from liver-directed and liver-specific management.

Can you describe a typical patient in your clinic?

Prof. Dr. Jörn Schattenberg: The patients I see in my clinic have typically been overlooked for a long time. So they are diagnosed very late. In the hospital system, we see patients with advanced liver disease, cirrhosis, or even decompensated cirrhosis. And although their underlying liver disease has been present for 20 to 30 years, it has not really been identified or managed. Until recently, the tools available to identify liver disease have been limited.

Why is there an increasing interest in metabolic liver disease?

Prof. Dr. Jörn Schattenberg: I think there is a great deal of interest in the liver and internal organs among patients in general. For patients, the heart is very easy to visualize. It pumps blood. But the liver is a very silent organ in terms of its function and its role in metabolism. Traditionally, patients have shown a great deal of interest in understanding liver health and liver disease. We are now seeing increased awareness at multiple levels. And, of course, the major change is that we have seen the approval of a drug based on positive phase 3 data.

How do you see patient identification evolving in the future?

Prof. Dr. Jörn Schattenberg: For the patients I see in my clinic with advanced disease, I would have liked to identify them earlier. So my vision for promoting liver health goes beyond preventing disease. I want patients to have healthy livers because the liver is also important for other organs. We are talking about the role of the liver and metabolism in the heart, the brain, and the kidneys. By preventing fat from accumulating in the liver or treating existing fat accumulation, you can have a lasting impact on the patient's disease trajectory. If I can empower patients to make changes for themselves, this may include changes in lifestyle or behavior. And patients can influence the trajectory of their liver disease. That would be my vision. And I think, for that reason, we need to raise awareness. We have to identify the patients who are at risk of progression. And even at a societal level, we may need to provide more education about the risk factors that lead to liver disease.

Doing now what patients need next - Roche