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Association between post-treatment alpha-fetoprotein reduction and outcomes in real-world US patients with advanced hepatocellular carcinoma


March 2023


Abou‐Alfa GK, Wang X, Parrinello CM, et al. Association between posttreatment α‐fetoprotein reduction and outcomes in real‐world US patients with advanced hepatocellular carcinoma. Cancer. 2023. doi:10.1002/cncr.34754


Patients with hepatocellular cancer (often referred to as “liver cancer”) usually have a poor prognosis. Therefore, it is particularly important to know early if (and how much) a treatment is working or not. 

Alpha-fetoprotein (AFP) is a glycoprotein expressed by hepatocellular carcinoma (HCC), and elevated serum levels are observed in 60-80% of patients with HCC. AFP has been explored as a prognostic and predictive tumor marker for HCC screening, diagnosis, and treatment. Previous analyses suggested that AFP reduction may be a useful prognostic marker. However,  most of the studies were small and the definitions of AFP reduction were inconsistent 

To address this research gap, researchers from MSKCC, Moffitt Cancer Center, and Flatiron Health examined patients with aHCC who had received first-line tyrosine kinase inhibitor treatment, and had baseline and post-treatment AFP values. This real-world study aimed to determine whether longitudinal changes in AFP during treatment have prognostic implications for patients with aHCC.

Why this matters

This study is among the first and largest studies to investigate how changes in AFP levels after treatment affect the survival outcomes for real-world aHCC patients in the US. Previous evidence of prognostic values of AFP levels was based mainly on clinical trial data that may not represent the general patient population treated in routine practice. By leveraging a large nationwide cohort of patients that included confirmed HCC diagnosis, etiologic risk factors, and progression of HCC, researchers were able to evaluate both progression-free survival and overall survival outcomes, as well as the interaction between baseline and post-treatment AFP levels which could provide more insights into the prognostic value of AFP as a noninvasive biomarker. 

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