The Japan
GastroenterologicalEndoscopy Society

The Japan
Society for
Portal Hypertension

The Japan
Society of
Hepatology

The JapaneseLiver Transplantation
SocietyTokyo

The Japanese Societyof Gastroenterological
Surgery

The JapaneseSociety of
Gastroenterology

The LiverCancer Study
Group of JapanThe Organizationof JDDWTUESDAY, 23 February 2016

InsideRadiofrequency Ablation (RFA) KnowHow in 2 Days
03
LDV/SOF Efficacious in HCV Patientswith Decompensated Cirrhosi
04
Switching PEG-RBV to DAAs in Patients
Chronic Infected with GT 1b HCV 06
New Drugs to Overwhelm the Barriers
to Eliminate HCV
08

Today

At 38 Years, justYoung and Robust

6℃—25th APASL opening
ceremony

12℃
Produced by:
HEPATOLOGY DIGEST
www.ihepa.com:8088/pc/41/
special/index.html

Editor-in-chief: Hui Zhuang

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服务号：ihepa-S

Not very often would you have amember of a royal family address a medical
academic conference.

And here at the 25th APASL in Tokyo, you
saw it happen and felt proud and experienced
the special treat as a liver disease physician
or researcher when Princess Tomohito ofMikasa gave her welcoming speech to theaudience of hepatologists from the AsiaPacific region and from around the globe.

Combination Treatment in
HBV Infection

Although current HBV infection treatment regimens arehighly effective to suppress viral replication, reverse hepatic
fibrosis and prevent progress to liver failure, but low rate of
HBs Ag loss and persistency of risk of HCC, high cost anddrug resistance are still worrisome.

See More on Page 5"It is my hope that your research results
will find hope and shed light to patients
who are suffering and to show them apath for new life..." and with her speech,
Princess Tomohito kicked off the 25th
APASL with lofty expectations.

See More on Page 2

国际肝病手机网m.ihepa.com

iPad 电子报刊
App 下载地址

Perfect Performance of Radiofrequency Ablation toTreat Early HCC in Skilled Center

Because many patients with liver cancer can be detected in the early stages in Japan, up to 50% of patientscan be candidates for radiofrequency ablation (RFA), while in Professor Shiina’s center, almost 90% of newly
diagnosed HCC patients will receive RFA therapy.

See More on Page 7

2016daily3indd.indd 1

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At 38 years, just Young and Robust—25th APASL Opening Ceremony

Omata, the Honorary Presidentof APASL2016, as he reviewed
the history of APASL. Attendance
reached an historic high of 4,645
when the meeting was held in
Beijing, China, in 2010, according
to Prof. Omata.

Modern Hepatology

Your honor, my treat
Not very often would you have amember of a royal family address a
medical academic conference.
And here at the 25th APASL inTokyo, you saw it happen and felt
proud and experienced the special
treat as a liver disease physician or
researcher when Princess Tomohito
of Mikasa gave her welcoming
speech to the audience ofhepatologists from the Asia-Pacificregion and from around the globe.
“It is my hope that your research
results will find hope and shed lightto patients who are suffering and toshow them a path for new life...”and with her speech, Princess

Tomohito kicked off the 25th
APASL with lofty expectations.

Participants increased
About 75% of the world’s liverdisease patients live in the AsiaPacific area, which demands
better quality medical care fromtheir doctors. APASL has played
an important role in fostering
educational events and new
research data-sharing and has itself
witnessed rapid growth.
From 1978 to 2016, the numberof attendees at APASL annual
conferences has seen rapid growth,
increasing from a mere few hundred
to more than four thousand inrecent years, said Professor Masau

Embracing the recent
breakthrough in HCV treatment,
new discoveries in HBV treatment
and other technological advances,
we are entering a new modern
era in liver disease treatment,
said Prof. Osamu Yokosuka, thePresident of APASL2016.
With 1,500 papers submitted tothe conference, Prof. Yokosuka
welcomes all attendees from 60
different countries to Tokyo toenjoy a fruitful meeting.

diseases at APASL and take theopportunity to sightsee the beautiful
Tokyo.”Mr. Mike Brune from Chicago,
USA, and another first timer, says heis “pretty much still jet-legged, but
excited to be here”, and he is also
looking forward to take a look at thecity.
Dr. Aiping Lin, from China, amultiple APASL participant, says
she “has been able to get in touchwith up-to-date clinical knowledge
by attending APASL meetings andhas been the first in her area to bring
the new knowledge into her clinicalpractice.” When asked about her
impression of this conference so far,her answer is “exquisite”.

Happy and excited
Indeed, as a first time everparticipant at APASL, young
Dr. Kanthanadon Dittarot fromThailand will present his poster on
HBV, and he is “happy and excited“to attend.
Dr. Sanchit Budhiraja from
India, also young and a firsttimer, will present his poster at
the conference. “I want to learn
the new finding in treating liver

DON’T MISS TOMORROW
08:00 - 10:00

Room 1BC

CEV-HAP Symposium

10:20 - 12:20

Room 1BC

WHO Symposium

12:20 - 12:40

Room 1BC

Closing Ceremony

2

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Presidential Plenary
On February 22nd, six valuable studies were presented at Presidential Plenary session.

These findings, as well as the devoted efforts of all hepatologists, open a door to a better
future for patients with liver diseases.

Radiofrequency Ablation (RFA) Know-How in 2 Days
hosts six RFA training programs andeach course can enroll 99 doctors. The
programs are popular and the quotas arefilled every time.
The 2-day program is composedof comprehensive lectures, live
demonstrations and case studies.
Content of the lectures include thecurrent status of RFA, RFA devices,
ultrasonography, and so on. The live
demonstration includes presentationof three cases on whom RFA would
be performed the following day andTDF Effective in HBV Long-term Treatment
In past studies, tenofovir disoproxil
fumarate (TDF) has demonstrated highefficacy in short-term treatment witha very low resistance rate in chronic
hepatitis B (CHB) patients in China.
However, long-term treatment data waslacking.
Jian Sun PhD MD, representing
Jinlin Hou MD, Nanfang Hospital,
China, reported the outcomes of a 192week TDF monotherapy, phase III,22-centered clinical trial in treating
Chinese patients with CHB.

The researchers first treated subjects
with TDF monotherapy for 48 weeks
in an open-label study period, thenrandomized treatment to either TDF
300m g Q D o r a d e f o v i r d i p i v o x i l(ADV) 10mg QD. Patients with HBVDNA>105copies/ml were eligible for
initial randomization and subgrouped to
HBeAg-positive and -negative groups.
A total 497/512 (97%) subjects, with
198 HBeAg-positive and 299 HBeAgnegative, entered the open-label phase;and 252 subjects were randomized

10

8

8

6

6

4

4
LLD
BL

12

20-24

IM

FU

6

600

4

400

2
200

0
LLD

0
BL

12

20-24

IM

FU

S e r u m H B V- R N A i n R E P2139- C a
Responders

planned ultrasound examinations
conducted by participants, outlined Dr.
Shiina.
On the second day, the trainee has theopportunity to perform RFA on the threecases, using artificial ascites technique,contrast-enhanced ultrasound guidance
and fusion imaging. In the case studies,around 12 difficult to ablate cases fromparticipants’ hospitals are presented anddiscussed.
Through the intensive program,participants will be able to learn thecurrent status of RFA. The questionnaire
surveys after the program have revealed
overwhelmingly positive feedback fromthe participants. Many participants
remarked on the benefits of being
directly trained by noted interventional
oncologists in an academic environment
where interaction between teachers andstudents and group discussions wereencouraged.
In the future, the program will also holda longer-term training program for up to
two weeks. Additionally, the program
has expanded to include an international
training program for foreign doctors, withthe first one held in December, 2015,
according to Dr. Shiina.

to TDF follow-up treatment (TDFTDF) and 245 subjects randomized toreceive ADV (ADV-TDF) treatment.
The majority of subjects (95.5%) weretreatment naive.
The results demonstrated that at week
192, the majority of treated subjects(TDF-TDF vs. ADV-TDF) in HBeAgpositive (91.3 vs. 92.9%, P >0.05) andHBeAg negative (92.9 vs. 92.2%,
P >0.05), achieved virologic suppression(HBV DNA <400copies/ml). Also,
more than 80% of the subjects achieved
A LT n o r m a l i z a t i o n . T h e r e s u l t s
suggested that a higher proportionof subjects in the TDF-TDF groupexperienced HBeAg loss and HBeAg
seroconversion, but these differenceswere not statistically significant. No
subject experienced durable HBsAg
loss/seroconversion. No TDF resistancemutations were identified. More than
92% subjects completed the 192-weektreatment and TDF’s long-term safety
profile was as previously established.
In summary, TDF demonstrated
high potency, no resistance, and goodtolerability in Chinese CHB subjects
with 192-week monotherapy, Dr. Sun
concluded.
This trial was funded by
GlaxoSmithKline (GSK).

— Juntendo University radiofrequency ablation (RFA) training program
Although RFA has been a standard
treatment modality for liver tumors
for many years, it is highly operatordependent. RFA skills and outcomes aredifferent from operator to operator, andfrom institution to institution.
Shuichiro Shiina MD, Juntendo
University School of Medicine, which is
the highest RFA volume center in Japan,
introduced the RFA training program heldby his institution, aiming to disseminate
skills and know-how on RFA.
Each year, Juntendo University

10

LLD

HBsAg

treatment with a mean of 6.70 (SD0.83) logC/mL. After 20-24 weeks of
REP2139-Ca treatment, mean HBVRNA, HBV-DNA, and HBsAg levels
had declined significantly compared tobaseline (P <0.001).
At week 20-24, HBV-RNA wasundetectable in 8/12 patients. In 7 ofthese 8 patients, HBV-RNA remained
undetectable during the treatment-freefollow-up period (mean 21.9 weeks,
range 7-27). HBsAg seroconversion
was achieved in 4/8 patients duringfollow-up with anti-HBs ranging from200-766 U/L.
In conclusion, in patients treatedwith REP2139-Ca, serum HBV-RNA
levels decreased significantly compared
to baseline. REP2139-Ca may be a
promising new treatment option for
CHB patients, according to Dr. Reesink.
The trial was funded by Replicor Inc.

anti-HBs(CHB) patients. In total, 12 patientswith HBeAg-positive CHB were treatedwith nucleic acid based amphipathic
polymer REP2139-Ca for 20-38 weeks.
If the patients responded to REP2139
with clearance of serum HBsAg, thepatients would be subsequently treatedwith an add-on immunomodulatory
agent - pegylated interferon alpha2a and/or thymosin alpha-1. If thepatients didn’t respond to the treatment,
entecavir treatment followed.
HBsAg, HBV-DNA, and HBVRNA levels were determined atb a s e l i n e , a f t e r 20-24 w e e k s o f
REP2139-Ca monotherapy, and either
during a treatment-free follow-up(for responders) or during entecavir
treatment.
The results demonstrated that HBVRNA levels were detectable in all
12 HBeAg-positive patients before

HBV RNA

Wi t h t h e r e c e n t b r e a k t h r o u g hdiscoveries of DAAs in treating HCV,
it is widely believed that HCV is now
curable in the majority of patients. The
focus of research is now shifting to HBV,
hoping to copy the success story of HCV.
H e n d r i k W. R e e s i n k M D ,Department of Gastroenterology andHepatology, Academic Medical Center,
Amsterdam, Netherlands, reported theoutcome of the phase II clinic trial of
REP2139-Ca, a nucleic acid polymer(NAP), a promising new treatment
option that is being tested to treat
HBV infection by inhibiting HBsAg
release with the title “Serum HBVRNA levels decline significantly inchronic hepatitis B patients dosed with
REP2139-Ca.”The trial aim was to test the effectof REP2139-CA on HBV-DNA and
HBsAg levels in chronic hepatitis B

HBV DNA

REP2139-Ca, a Promising NAP to Treat HBV

3

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VEL/SOF Effective in HCV Patients with Decompensated Cirrhosis
As a second generation of DAAs,
velpatasvir (VEL) has demonstrated
high SVR rates in patients withgenotypes 1-6 HCV when used in
combination with sofosbuvir (SOF).
So could fixed dose combination of
SOF/VEX be used effectively andsafely in HCV infected patients withdecompensated liver disease?
Michael Charlton, MD,
Intermountain Medical Center, Salt
Lake City, USA, reported the outcomesof “Sofosbuvir/velpatasvir for thetreatment of HCV decompensated liverdisease patients: ASTRAL-4 study”.
The researchers randomized GT16 HCV infected patients with CPT-B
cirrhosis 1:1:1 to receive SOF/VEL(400 mg/100 mg) daily for 12 weeks,
SOF/VEL + weight-based ribavirin(RBV) (1000 or 1200 mg/day) for

12-weeks, or SOF/VEL for 24 weeks.
Patients with prior liver transplantor hepatocellular carcinoma were
excluded.
The trials was done in a US
population with 267 patients treated,most were male (70%), white (90%)
and treatment experienced (55%).
Patients had genotypes 1(78%), 2(4.5%), 3 (15%), 4 (3%) or 6 (<1%)
HCV infection. Although SOF/VEL+ RBV for 12 weeks resulted in high
SVR rates (95.6% compared with
83.3% and 85.6% of other groups),
there was 1 (1%) GT1 and 2 (15.2%)
G T3 s u b j e c t s w h o e x p e r i e n c e dvirologic failure and 1 GT3 patient
who had virologic breakthrough.
Among patients who achieved SVR,
47% and 56% had improvements in
CPT and MELD scores respectively at

12-week follow-up. Fatigue, headacheand nausea were the most common
adverse events.
Nine patients in total discontinued
SOF/VEL due to adverse events. 18%(47) patients experienced serious
adverse events and there were 9 deaths;
but none were attributed to the study
drug.
In conclusion, SOF/VEL + RBV
for 12 weeks resulted in high SVR
rates across all HCV genotypes indecompensated patients with early
improvements in liver function. This
regimen was well tolerated with AEs
consistent with clinical sequelae ofadvanced liver disease and side effectprofiles of RBV, according to Dr.
Charlton.
This clinical trial was funded by
Gilead Sciences.

LDV/SOF Efficacious in HCV Patients with Decompensated Cirrhosis
For HCV patients withdecompensated cirrhosis, or those whohave undergone liver transplant, there
are usually not many treatment choices
left. Could the emerging DAAs meetthe needs of these patients?
Edward Gane, MD, University of
Auckland, New Zealand, reported theoutcomes of a multinational (mainlyWestern European and North Americancountries), multi-centered clinical trial“LDV/SOF + RBV in HCV patientswith decompensated cirrhosis orliver transplantation: SOLAR-1 and
SOLAR-2” at APASL2016.
The researchers extracted data fromthe SOLAR-1 and SOLAR-2 studies, inwhich patients with HCV genotype 1 or
4 were randomized to receive 12 or 24
weeks of ledipasvir (LDV)/sofosbuvir(SOF) + ribavirin (RBV): patients
without a transplant with (1) ChildPugh-Turcotte (CPT) B or (2) CPT-C
cirrhosis; or transplanted patients with

(3) no cirrhosis (F0 to F3), (4) CPT-A,(5) CPT-B or, (6) CPT-C cirrhosis, or (7)fibrosing cholestasis hepatitis. Then the
researchers evaluated SVR12, relapse
and change from baseline in CPT and
MELD scores 12 weeks after the endof-treatment among those patients with
SVR12.
The outcomes of the trial were
striking. In the total of 667 patients,
27 were excluded because they have
not reached the post-treatment week
12 visit. Subjects with GT1 responded
better to the treatment. Overall, 92%(575 of 627 subjects) achieved SVR12.
That included 92% (545 of 590 subjects)
and 81% (30 of 37 subjects) in genotype
1 and genotype 4 infection, respectively.
The results also demonstrated thatthe relapse rates were low, only 4%
overall (23 of 598 subjects), being 4%(20 of 565 subjects) and 9% (3 of 33
subjects) in GT1 and GT4 infection,
respectively. The results suggested that

relapse occurred more commonly indecompensated patients, but was not
related to treatment duration, according
to Dr. Gane.
The authors used MELD score toassess liver function and CPT scoret o p r e d i c t p r o g n o s i s . O f t h e 250
decompensated patients who achieved
SVR12, 60% (150) had an improvement
in MELD scores from baseline to posttreatment week 12, 61% (41/67) withbaseline MELD >=15 had a posttreatment week 12 MELD<15, and 66%(164/248) had improvement in CPT
scores.
In short, LDV/SOF + RBV for
12 o r 24 w e e k s i n p a t i e n t s w i t hdecompensated cirrhosis or recurrent
HCV was efficacious with low relapse
rates. And most patients with SVR12
also had improvements in CPT and
MELD scores, concluded Dr. Gane.
This research was funded by Gilead
Sciences.

AARC-ACLF, the Better Prognostic Score—AARC-ACLF Score predicts 30-day survival better than CLIF-SOFAand MELD scores in patients with
ACLF
Acute-on-chronic liver failure(ACLF) is associated with the rapid
worsening of liver failure and highmortality. A well-validated scoring
system used to predict survival and earlyintervention can improve outcomes.
The challenge was to build a prognostic
model in patients of ACLF by APASL’s
definition that is better than existing
MELD and CLIF-SOFA scores.
Ashok K Choudhury, MD, Instituteof Liver and Biliary Sciences, New
Delhi, India, representing the APASLACLF Research Consortium (AARC),
reported that based on his research from1021 patients, the AARC-ACLF could

be the answer.
The researchers enrolled a total 1021
ACLF cases with 90 days follow-up
into the analysis, with a derivation setof 338 cases analyzed for a prognostic
model and calibrated in 683 cases as avalidation set.
The results demonstrated that of all
the baseline independent predictors ofmortality, total
bilirubin, creatinine, lactate, INR andhepatic encephalopathy were considered.
AUROC in derivation and validation
cohorts were 0.797and 0.793 respectively.
AARC-ACLF score was developed witha minimum and maximum of 5 and 15.
The score was better than the
MELD and CLIF-SOFA with an

AUROC of 0.76, sensitivity of 70%,
specificity of 67%, PPV of 78% and NPVof 58% in predicting 90 days survival.
Grading was done with Grade A (5-9),
Grade B (10-11) and Grade C (12-15
points). The mortality risk increases by
9.7% with each unit increase. Score of 11
at baseline or persistence of the same in
the first week was associated with 100%
mortality in 30 days. Overall, mediansurvival was 26.3 days and for Grade
B and C, 16 and 5 days respectively.
Overall survival was 51.8%.
In short, he AARC-ACLF score is
dynamic, simple and better than theexisting models. Definitive therapies liketransplant can be predicted within thefirst week, Dr. Choudhury concluded.

4

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Combination Treatment in HBV Infection

Jinlin Hou“Today is limited,tomorrow is
promising, the CHB
cure will come true
within the next 5-10
years!”

Although current HBV
infection treatment regimens arehighly effective in suppressing
viral replication, reversing hepatic
fibrosis and preventing progress toliver failure, low rates of HBsAg
loss, the persistent risk of HCC, highcost and drug resistance are still
worrisome, stated Prof. Jinlin Houfrom Nanfang Hospital, Guangzhou,
China, and the President Elect of
APASL 2017, at a lecture at the Post
Graduate Course at 25th APASL on
Feb 20th.

Would combinations withother newer drugs, namely
the oral antiviral agent
nucleos(t)ide analogues(NAs), with pegylated
interferon work better?
The main finding in the
SWITCH (OSST) study was “forpatients who achieve virologicalsuppression with ETV, switching to a
finite course of pegylated interferon

alfa-2a significantly increased ratesof H BeA g s eroconvers ion and
HBsAg loss”, according to Prof.
Hou. And in the New SWITCH
study, the patient group who had
an early response (HBsAg<200 IU/
ml at 24 weeks) regardless of theirbaseline, had shown better HBsAg
loss at 48 weeks of treatment.

What about combinationsof different new NUC
agents?
Dr. Hou introduced the EFFORT
study to address this approach.
From the two-year outcomes, it
seemed that the telbivudine (LDT)
optimization strategy demonstrated
superiority to LDT monotherapy
for HBeAg-positive HBV patients,
with 77% vs. 61% in virologicalresponses and 2.7% vs. 25.8% in
genotypic resistance, respectively.
While HCV infection has
welcomed breakthrough treatment
advances recently, understandably,
people now shift the same

expectation to HBV infection
treatment.
From the many exciting small
molecule host-targeting agents
under investigation, Dr. Hou focusedon nucleic acid polymers (NAP),
which prevent sub-viral particle(SVP) formation in HBV-infected
hepatocytes and inhibits HBsAg
release. From a phase II clinical
trial result in a small number ofpatients, the combination of NAP
with pegylated interferon alfa-2aachieved high SVR rates.
“Triple combination therapy
with NAPs (with pegylated
i n t e r f e r o n a l f a -2a + T D F ) a n d
existing approved treatment is likely
to achieve high SVR rates”, said Dr.
Hou.
For the choices of treatmentof chronic hepatitis B and as
quoted by another hepatologist,
Dr. FS Wang in China, Dr. Houshared an optimistic vision for thenear future - “Today is limited,tomorrow is promising, the CHB
cure will come true within next
5-10 years!”J

apan's past is rich in events and interesting
history, but today's Japan is just as fascinatingwith cutting edge technology and wonderfularchitecture, whilst still maintaining the country's
traditions. As the capital of Japan, Tokyo offers it'svisitors a seemingly unlimited choice of shopping,entertainment, culture and dining. Whether you
want to experience food like you’ve never tasted(or seen!) or you want to go shopping in some of theworld's best shopping districts, Tokyo is the place
to visit!

Discovering Tokyo Modern and Energetic

5

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Switching PEG-RBV to DAAs in Patients
Chronically Infected with GT1b HCV

Guofeng Chen

In today’s Free Paper Session,
Dr Guofeng Chen from Beijing 302
Hospital of PLA, China will present
their results of Switching PEG-RBV
to DAAs for Chinese with Chronic
Hepatitis C GT1b.
Chronic hepatitis C is prevalent
in China and the major genotype is
1b. Standard treatment is pegylated
interferon plus RBV (PR). Beijing
302 H o s p i t a l o f P L A a n d t h e
Humanity & Health Medical Center(Hong Kong) jointly establishedthe HCV Diagnosis and Treatment
Center in 2013. New regimens havebecoming increasingly available
since 2013.
Some patients have used the PR
therapy and have attained RVR or
EVR, but they suffered and could
not tolerant adverse reactions as wellas the long duration of treatment. Dr
Chen and her colleagues switched
PR to DAAs to treat those patients
who gave informed consent.
This clinical study wasprospective, real-life research. 129
consecutive CHC GT1b Chinesepatients who were initiated with PR
and had completed early virologic
response were studied. 20 (16%)
discontinued PR therapy, due toPR-intolerance and were switched
to 4 (n =10) or 8 (n =10) weeks of
Harvoni® (ledipasvir/sofosbuvir) at
the patient’s discretion. The first aim
was to identify the SVR of Chinesechronic hepatitis C patients treatedwith PR therapy after switching toa pan-oral direct-acting antiviral
agents strategy. The second aim
was to evaluate the safety and costeffectiveness of a DAA strategy.
A simplified Markov model
was used for decision analysis.
It simulated the progression of
a 50-year-old chronic hepatitis
C , g e n o t y p e 1b c o h o r t , u n d e r
different SOF-based therapeuticstrategies. The initial populationconsisted of both treatment-naïve
and -experienced patients by sex
and fibrosis stages (F0-F4 anddecompensate cirrhosis defined by
METAVIR score). Subjects canprogress through fibrosis stages F0F4, DC based on natural progression
rates. Fibrosis regression after SVR
is possible for subjects in stage F3
and F4. Further fibrosis progression
to HCC and liver transplant after
SVR is possible for subjects instages F4 and DC at lower rates.
An annual discount rate of 3% wasapplied.
The authors used real-world
data from their centers to evaluateclinical effect and costs. Diseaseprogression and QALYs data weretaken from literature. A cycle of
4-weeks was applied in the first 52
weeks and yearly cycle was applied
afterwards. Outcome measures
include discounted cost (in 2014
US$), quality-adjusted-life-year(QALY), and incremental cost-effectiveness ratio (ICER).
The results shows that for PR
therapy in CHC GT1b patientswith cEVR, switching to 4-8 weeks
Harvoni® is safe, effective and costeffective. All CHC patients treated
w i t h H a r v o n i ® h a d S V R12 a scompared to 52/109 who continued
P R t h e r a p y (100 % v s . 48% ,P <0.0001) . C o m p a r e d t o P R48,
PR12+ 4 weeks Harvoni and PR12+8 weeks Harvoni gained 1.173 and1.168 Q A LY s , P R12+ 4 w e e k s
Harvoni® have a cost saving.
The authors concluded thatwhen CHC patients got EVR on
PR treatment but were intolerant
to the severe side effects, we canswitch therapy to DAAs. They also
noted the limitation of the small
size of this study and the undefined
equivalence between 4-week and8-week treatments.
(From: Chen GF, Second Liver

Cirrhosis Diagnosis and Treatment
Center, 302 Hospital, Beijing, China)

Free Paper “Switching PEG-RBV
to DAAs for Chinese with
Chronic Hepatitis C GT1b”(11245)08:50 - 10:30
Room 5What to Watch out for Today
LectureRoom 1BC 	
Room 1BC 	

10:45 - 11:05 	
11:05 - 11:45

		Room 1BC 	

15:15 - 15:35

Room 2

Room 1D

Future Perspective of Hepatology

Okuda Oration-Acute on Chronic Liver Failure:

APASL ACLF Research Consortium (AARC) - A Proud Asian Initiative

Eugene R. Schiff
Shiv K. Sarin

Disorders of Iron and Copper in the Asian Pacific Region

Lawrie W. Powell

09:10 - 09:30

Noninvasive (Genetic) Predictor of NASH

Yoshito Ito

10:45 - 11:05

Treatment of Advanced HCC in BCLC B/C Treatment

Massimo Colombo

PBC and GWAS

Lai Wei

General Session 7. Update of NASH/ASH Research
Symposium 13. Recent Trend in HCC Treatment
APASL-AASLD Joint Meeting
9:30 - 9:50		
9:50 - 10:30		

APASL-EASL Joint Meeting

Epidemiology of Primary Biliary Cholangitis: East and West

W. Ray Kim

Room 3

15:50 - 16:15

Autoimmune Liver Disease:EASL Clinical Practice Guidelines and Future Directions 	

Tom Hemming Karlsen

Room 3

16:40 - 17:05

Non-Invasive Diagnosis of Fibrosis: EASL Clinical Practice Guidelines and Future Directions

Laurent Castera

Room 3

16:15 - 16:40

Non-Invasive Diagnosis of Fibrosis: APASL Clinical Practice Guidelines and Future Directions

Hiroshi Yatsuhashi

62016daily3indd.indd 6

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Perfect Performance of Radiofrequency
Ablation to Treat Early HCC in Skilled Center
This morning, Professor
Shuichiro Shiina, from the
Department of Gastroenterology,
Juntendo University, Japan will share
his experience on local treatment of
hepatocellular carcinoma (HCC),
mainly focusing on radiofrequency
ablation (RFA) .
Because many patients withliver cancer can be detected in theearly stages in Japan, up to 50%
of patients can be candidates forradiofrequency ablation (RFA),
while in his center, almost 90% of
newly diagnosed HCC patients will
receive RFA therapy, explained
Professor Shiina in a interview with
APASL Daily. His center has one of
the highest volumes of RFA cases inJapan.
According to Professor Shiina,
RFA has many advantages oversurgical resection to treat HCC, “itis much less invasive than surgicalresection. Elderly patients (>85
years) or those with advanced livercirrhosis or with cardiopulmonary

complications can be candidates
f o r R FA p r e f e r e n t i a l l y o v e r
resection. Because of the reduced
invasiveness, RFA can be repeatedin the case of recurrence. At our
institution, almost 90% of patientswith recurrence can be treatedagain with RFA. Using surgicalresection, maybe only 20% of
patients can be candidates for
repeated resection.”
RFA has demonstrated highefficacy and a favorable safety
profile. In his center ’s 10-year
experience of RFA, final CT showed
99.4% of complete tumor ablation.
With a median follow-up of 38.2
months, 5- and 10-year survivalr a t e s w e r e 60.2% a n d 27.3% ,respectively. On the other side, thecomplication rates using RFA havebeen remarkably decreased in recent
years. The frequency of the mostcommon complication, bleeding(hemoperitoneum or hemothorax),
is <0.5% nowadays, said Professor
Shiina.

Welcome Message

Jinlin Hou
Dear Colleagues,
We are delighted and honored to
introduce you to the 26th Conferenceof the Asian Pacific Association for
the Study of the Liver (APASL),
which will take place in Shanghai,
China. We will bring together adistinguished faculty of renowned
specialists from the Asia-Pacificregion and from around the world tothis conference.
The APASL Annual Meetinghas grown as the leading conference
focusing on remarkable advancesin liver disease, aimed at providing
the latest scientific and evidence-“At our institution, almost
90% of patients withrecurrence can be treatedagain with RFA. Using
surgical resection, maybe
only 20% of patients canbe candidates for repeatedresection.”
At the end of the interview,
Professor Shiina noted how toevaluate the risk of HCC recurrence
and death after RFA. “There are twokinds of recurrence in HCC. One isrecurrence distant from the primarysite and the other is local tumor
progression and local recurrence.
With regard to distant recurrence,
the tumor size and number andserum tumor marker levels are
significantly related to recurrence
from the primary site. For local
progression or recurrence, the tumor

Shuichiro Shiina
size is the main factor. Overall,
the factors related to survival areage and in Japan, the presence ofhepatitis C, tumor size and number,and the serum tumor marker levels
such as AFP-L3.”

Symposium 11: Update of
HCC Treatment - “Local
Treatment of HCC”
10:10 - 10:30
Room 1D

based research results that will
be applicable to everyday clinicalpractice. It provides an excellent
opportunity to share and exchange
experiences especially from theviewpoint of Asian-Pacific countries.
These elements are essential to pave
the way for the further developmentof hepatology.
We plan to have a three-day coreprogram to provide an overview
of various liver diseases with theState-of-the-Art Lectures on hotoff-the-press issues. Additionally,
Postgraduate Courses and Morning
Sessions will be designed for the indepth discussion of particular topics.
Free paper and poster presentations
are always the soul of the conference toshare research findings and there will
be several awards available aimed at
supporting young scientists to attend
the conference and encourage scientificresearch.
We thus enthusiastically invite
you to submit abstracts and join us
at this conference as well as ourblooming city, Shanghai.
We look forward to welcoming
you in Shanghai!
Jinlin Hou, M.D., PhD
President, APASL 20177

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New Drugs to Overwhelm the Barriers to
Eliminate HCV
Only 25 years from the discoveryof the hepatitis C virus, a cure is now
likely for most people afflicted withthis chronic infection. The recent
approval of several direct-acting
antiviral agents has dramaticallyincreased the viral clearance rate toover 90%. As Dr Eugene Schiff says,
once treatment programs get going,in thirty years, the disease could be
expected to be eradicated.
Ho we v er, b arrie rs ex is t o n
the road to curing HCV infection.
According to Dr T. Jake Liang in aninterview with APASL Daily, “costis a major challenge.” Dr Liang is
a former President of AASLD2011,
from the National Institute of
Diabetes and Digestive and Kidney
Diseases, National Institutes of
Health, USA. He gave an excellent
speech on the topic of Challenges
and Prospects of HCV Therapy

Beyond the DAAs at APASL2016.
He told APASL Daily that with thecurrent price of the drugs, many
people and countries of low- to midincome level couldn’t afford them.
“The cost of treatment would haveto go down significantly first before
we can consider eradication”, said
by Dr. Liang.
Additionally, diagnosis andaccess to appropriate healthcare andtreatment for the majority of people
infected with HCV is another major
problem. Other challenges include
further reducing the treatment
duration, and who should to betreated and with what regimen. Also,
there remain difficult-to-treat patient
populations.
To address these remaining
challenges, one of the options is todevelop new drugs targeting otherviral or host factors.

“The cost of treatment
would have to go down
significantly first before wecan consider eradication”.
When asked his opinion on
the role of host-targeting agentsfor treating hepatitis C, Dr. Liang
believes it is a viable alternative
to DAAs “because host-targeting
agents have less of an issue withdrug resistance and are likely to be
active against all HCV genotypes.
T h e m i R -122 i n h i b i t o r s o u n d s
promising in early clinical trials.
Entry inhibitors such as antibody orsmall molecule-based therapeutics
have shown promise not only as
preventive but also in therapeuticstrategies.”
Also Dr. Liang believes that

T. Jake Lianga vaccine is necessary to prevent
new infections, especially in highrisk populations or high-prevalencecountries. “However, the lack ofconvenient animal models to test
vaccine candidates is probably
the most significant barrier to thedevelopment of an effective vaccine.
The other barrier to development ofan effective HCV vaccine is a dearthof funding opportunities in both theprivate and public sectors.”

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