The Asia Pacific Primary Liver Cancer Expert Meeting (APPLE) 2023 returned offline emphasizing the need to prevent the causes of liver cancer such as hepatitis B and C, as rapidly changing treatment guidelines make the new liver cancer treatments difficult to apply in clinical settings.

“The treatment paradigm for liver cancer is changing rapidly so there is no time for studies on the effectiveness of these treatments,” said Professor Kim Kang-mo of gastroenterology at Asan Medical Center who chairs the Scientific Committee of APPLE 2023. “The currently available treatments have been proven as effective primary treatments but it is difficult to find studies on secondary treatments for those who fail primary treatments contributing to poor survival rates.”

The 13th edition of the conference, which runs through Saturday, will celebrate the theme, “Novel Insights into the Evolution of Liver Cancer Management."  

The main research results of the conference were announced by the Korean Liver Cancer Association in a press conference held on Friday in Seoul.

Professor Choi Joon-il of Radiology at Catholic University of Korea-Seoul St. Mary’s Hospital, who serves as the Director of Public Relations of APPLE 2023 released the liver cancer incidence in Korean patients after hepatitis B antigen clearance.

The probability of developing liver cancer within 15 years is 6.8 percent, with an increased risk in men over 60 years of age, and those with pre-existing cirrhosis, he said.

He also noted that the combination of atezolizumab and bevacizumab, a first-line treatment for liver cancer, significantly reduced the risk of recurrence or death in patients who had undergone liver resection for liver cancer. 

Also, the long-term follow-up results of the combination of tremelimumab and durvalumab, recently approved by the FDA for the first-line treatment of liver cancer, showed a 22 percent reduction in the risk of death compared to conventional therapies.

The use of hepatocyte-specific MRI contrast agents in MRI for the diagnosis of liver cancer was also found to be significantly superior to the diagnosis of typical hepatocellular carcinoma (HCC).

Professor Park Young-nyun of Pathology at Yonsei University College of Medicine who serves as the Hosting Chairperson of APPLE 2023, said the pathology of liver cancers adds to the treatment complexity. 

“Subtypes of liver cancer need to be differentiated to develop targeted treatments for different types of liver cancer such as cholangiocarcinoma to improve survival rates,” said Park.

Regarding Korea's newly revised liver cancer guidelines, Kim said guidelines differ according to country but there is a consensus between countries on the performance of combination therapy. 

In particular, Korea is stronger in terms of liver cancer drugs compared to other cancers due to Korean experience in dealing with hepatitis B, a leading cause of liver cancer, said Kim.

The conference will feature discussions on the changing etiology and epidemiology of liver cancer and new concepts in liver cancer imaging in the era of AI, new classification methods for liver cancer to develop precision medicine, and multidisciplinary liver cancer treatment, alongside workshops.

International speakers include Professor Norihiro Kokudo of the National Center for Global Health and Medicine in Japan, Professor Kathryn J. Fowler of the University of California San Diego, and Dr. Ghassan Abou-Alfa of Weill Cornell College at Cornell Univ. in the U.S. In particular, Professor Fowler will speak on the diagnosis of liver cancer and when to consider liver biopsy to assess prognosis. 

"We hope that APPLE 2023 will raise the level of liver cancer care in the Asia-Pacific region to the next level and serve as a venue for international exchange and collaboration," said Professor Park, President of APPLE 2023.