The largest clinical trial in history related to liver cancer screening is launching in 2023, funded by the Department of Veterans Affairs. The project is scheduled to recruit 4,700 veterans with cirrhosis from 47 VA medical centers. Cirrhosis is a major risk factor for liver cancer and affects veterans disproportionally.
One of the two scientists co-chairing the trial is Tamar Taddei, MD, chief of Gastroenterology at VA Connecticut Healthcare System. Taddei said she and her co-chair on the project, George Ioannou, MD, MS, of the VA Puget Sound Healthcare System, feel that this is the defining moment of their careers.
“The VA is a phenomenal place to perform research, and veterans have many risk factors for liver disease and liver cancer,” she said. “We're both VA doctors, we've spent our careers in the VA, and we feel very strongly that we have to answer a question that has been a puzzle for so many decades.”
The study, known as PREMIUM — PREventing Liver Cancer Mortality through Imaging with Ultrasound vs. MRI — aims to determine whether screening for liver cancer with abbreviated magnetic resonance imaging (aMRI) is more effective at detecting the disease in early stages than ultrasound—the current standard of care in screening. The co-chairs hypothesize that early detection will reduce liver cancer deaths in veterans.
“Ultrasound is a fairly insensitive screening test,” Taddei said. “A standard MRI, which typically takes around 45 minutes, is considered the gold standard for diagnosing liver cancer. By using an abbreviated version, the test will be comparable in length to an ultrasound (about 15-20 minutes), making it more viable as a screening method. The abbreviated MRI encompasses all of the sequences that are required for a diagnostic test for liver cancer.”
This effort is a part of the Biden-Harris Administration’s Cancer Moonshot to ‘care for those with cancer and end cancer as we know it.’ Liver cancer is the sixth leading cause of cancer-related death in the U.S. This is the first clinical trial to compare the two screening methods. Enrollment will begin in 2023 and follow participants over an 8-year period.
“We are going to be following patients throughout the life of the study to determine if there's a difference between ultrasound and abbreviated MRI in terms of liver cancer-related mortality,” said Taddei.