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Africa Guidelines for Hepatocellular Carcinoma Buildup Process
Ghassan K Abou-Alfa1,2,3, Mary Afihene4, Marinela Capanu1,2
1Memorial Sloan Kettering Cancer Center, New York, NY.
Insights
Hepatocellular carcinoma (HCC) care in Africa faces significant access and availability gaps, particularly in Central and East/West Africa. Concerted efforts are needed to reduce HCC incidence and mortality across the continent.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) is a major health challenge in Africa, with a survival rate of only 3 months.
- Low GDP, limited HDI, and lack of guidelines contribute to poor outcomes.
Purpose of the Study:
- To assess real-world access to screening, diagnosis, and treatment for HCC in different African regions.
- To identify disparities in HCC care across North/Southern Africa (NS), East/West Africa (EW), and Central Africa (C).
Main Methods:
- An open forum with HCC experts was conducted in October 2021.
- Participants (372 from Africa) completed a survey on HCC management practices and resource availability.
Main Results:
- Hepatitis B vaccination and treatment are common; however, advanced diagnostics like image-guided biopsy are underutilized (20%).
- Liver transplant availability is very low (28% NS, 3% EW), and resection is limited in Central Africa.
- Access to systemic therapies like sorafenib is widespread (66%), but second-line treatments and newer agents (e.g., immune checkpoint inhibitors) are scarce.
Conclusions:
- Significant disparities exist in HCC care across Africa, with Central and East/West Africa facing the most substantial gaps.
- Multidisciplinary collaboration is essential to improve HCC management and reduce mortality continent-wide.
Purpose:
Hepatocellular carcinoma (HCC), the fourth most common cancer in Africa, has a dismal overall survival of only 3 months like in sub-Saharan Africa. This is affected by the low gross domestic product and human development index, absence of coherent guidelines, and other factors.
Methods:
An open forum for HCC-experienced health care workers from Africa and the rest of the world was held in October 2021. Participants completed a survey to help assess the real-life access to screening, diagnoses, and treatment in the North and Southern Africa (NS), East and West Africa (EW), Central Africa (C), and the rest of the world.
Results:
Of 461 participants from all relevant subspecialties, 372 were from Africa. Most African participants provided hepatitis B vaccination and treatment for hepatitis B and C. More than half of the participants use serum alpha-fetoprotein and ultrasound for surveillance. Only 20% reported using image-guided diagnostic liver biopsy. The Barcelona Clinic Liver Cancer is the most used staging system (52%). Liver transplant is available for only 28% of NS and 3% EW. C reported a significantly lower availability of resection. Availability of local therapy ranged from 94% in NS to 62% in C. Sorafenib is the most commonly used systemic therapy (66%). Only 12.9% reported access to other medications including immune checkpoint inhibitors. Besides 42% access to regorafenib in NS, second-line treatments were not provided.
Conclusion:
Similarities and differences in the care for patients with HCC in Africa are reported. This reconfirms the major gaps in access and availability especially in C and marginally less so in EW. This is a call for concerted multidisciplinary efforts to achieve and sustain a reduction in incidence and mortality from HCC in Africa.
