“In the early 90s, during my physical, [the doctors found] that I had hepatitis C,” says Dan, as he recounts the start of his thirty-year battle with liver disease and cancer. At the time there was no real remedy for it, so I didn’t really get rid of it until the last five years. Only after they tried to treat the cirrhosis of the liver, I found out I had liver cancer. It knocked me for a loop.”

Hepatitis C is an infectious disease that causes liver inflammation and can permanently damage the liver. Although curable, many people only learn they are infected much later, as symptoms often don’t appear for years. In some cases, as Dan experienced, unchecked hepatitis C can lead to cirrhosis – liver scarring so severe it prevents the organ from functioning properly and is one of the main risk factors for developing liver cancer.

Despite living with hepatitis C for years and even after a diagnosis of cirrhosis, Dan had no idea his chronic liver disease could lead to cancer. He says that learning the connection and discovering he had another health battle to fight left him ‘sad’ and ‘disappointed’ for a while.

But, as he has progressed through the care pathway, he’s found a new perspective and a light at the end of the tunnel. “You always look forward to seeing the sun come up and taking the next breath,” he muses. “That’s part of the deal, whether you acknowledge it or not.”

Dan’s story is far from unusual. In fact, he is one of millions of people living with a chronic liver disease which puts them at increased risk of liver cancer. Almost one in five people globally has a type of chronic liver disease, a term which spans conditions such as hepatitis (and HCV), non-alcoholic fatty liver disease (NAFLD)/ non-alcoholic steatohepatitis (NASH) and liver cirrhosis.1

Today, these conditions together with liver cancer cause roughly 1 in 30 human deaths.1,2 Worryingly, the number of people living with liver disease has increased from 1.5 billion in 2017 to 1.6 billion in 2019.1,3 This increase – linked to complex causes including alcohol consumption, rising obesity rates and infections such as hepatitis – means that the number of patients progressing to liver cancer is also increasing at an alarming rate. In fact, liver cancer is now the sixth most common cancer in the world.3,4

But with greater awareness, early detection and effective management, we at Roche believe it is possible to break the link between liver disease and cancer – and ultimately save lives. This is why we launched the global initiative, ‘One Liver’.

Our goal is to disrupt the trajectory of liver diseases and one day cure liver cancer. To do this, we need to examine the entire disease continuum and most importantly, collaborate.

The programme brings together diverse teams of internal and external experts including medical leads and Roche teams globally, liver specialists, research scientists and patient organisations, who all share a passion for reducing the number of people living with liver cancer.

The teams work together to understand real-world challenges faced by patients and physicians in diagnosing and treating chronic liver disease and develop solutions to address them.

It sounds simple in theory, but the reality is much more complex. Encouraging early diagnosis and best care is complicated by the diverse causes of chronic liver disease globally, which means a one-size-fits-all approach won’t work; solutions must be tailored to address local nuances.

With Asian and African countries being among the most afflicted by, the most common type of liver cancer, these regions have been a key priority for the One Liver programme.

In Asia, the team has initiated the Liver Ecosystem Advancement Project to uncover key gaps in the local liver care ecosystem and identify the most impactful solutions, in partnership with the patients themselves, healthcare professionals, policymakers and other industry players.

The specific focus differs according to local country needs: for example, in Singapore, the priority area for the project is to eliminate HCC by preventing progression of cirrhosis to cancer; in Thailand and South Korea, the focus is to improve early HCC detection and patients' access to treatment options.

In China, the team has been working on a pilot project to drive early screening and diagnosis, with the first phase of ‘Project Pearl’ focused specifically on Zhuhai Hospital. Here, the team plans to implement a standardized follow-up scheme based on each potential HCC patient's risk profile. Roche will provide the hospital with testing equipment, funding for operation, and potentially treatment and innovative payment, which are all enabled by an integrated Roche-designed digital platform offering simple step-by-step guidance to support early diagnosis and risk stratification.

In Africa, the priority for the One Liver team is to increase screenings for liver cancer to support earlier diagnosis and treatment.

To achieve this goal, the team has brought liver and rare disease patient groups from across Africa together to discuss shared objectives and ways to work together, while engaging with specialist professional societies to build local capacity and increase training for healthcare providers. A digital communications campaign will aim to raise awareness of the signs and symptoms of liver cancer among people with hepatitis and highlight the need for patients to visit their health provider for more information.

Within Europe, the UK – where liver cancer incidence rates are projected to rise by 38% between 2014 and 2035 – has been a key area of focus for the team.5

Roche is working in partnership with the University of Manchester and other stakeholders as part of the Integrated Diagnostics for Early Liver Disease (ID-Liver), a three-year project funded by the UK Industrial Strategy Challenge Fund, to revolutionise patient care and improve early diagnosis in key disease areas including cancer and liver disease.

“The One Liver initiative is a fundamentally different way in which we are listening to and engaging with patients, HCPs, external ecosystem stakeholders, and marrying that with internal expertise to reach a common goal of improving the lives of patients around the world,” says Mohamed ElGhareeb, Lifecycle Leader Gastrointestinal (GI) Cancers at Roche.

“We are excited to see the impact of this new era of co-creation and partnership through our One Liver programmes in Asia and Africa, along with those we have launched more recently in Europe and Canada and those that are still in the making.”

“We have big aspirations for what One Liver could achieve for the liver cancer community on a global scale, but individual patients like Dan are always in our minds – they are the driving force behind all that we do.”

For Dan, he will never know whether earlier diagnosis or access to increased surveillance might have changed his liver cancer prognosis. Luckily, he is still doing well with his wife by his side.

“I got married last year and my whole attitude about living has really improved,” Dan says. “I'm smiling and feeling better.”

“I might be here a little longer,” he chuckles.

References

  1. Moon AM, Singal AG, Tapper EB. Contemporary epidemiology of chronic liver disease and cirrhosis. Clin Gastroenterol Hepatol. 2020;18(12):2650-2666.

  2. Asrani SK, et al. Burden of liver diseases in the world. Journal of Hepatology. 2019;70(1):151–171.

  3. Global Burden of Disease Study. 2019. [Internet; cited 6 January 2021]. Available from:

  4. World Health Organization. Globocan 2020 – Liver cancer factsheet [Internet; cited October 2021]. Available from:

  5. Cancer Research UK. Liver cancer incidence statistics. [Internet; cited October 2021]. Available from:

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