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New York Times
3 days ago
- Health
- New York Times
3 Out of 5 Liver Cancer Cases Are Preventable, Study Finds
Liver cancer kills more than 700,000 people a year. But three in five cases could be prevented, according to a comprehensive analysis published on Monday in the journal Lancet. The research found that prevention could be accomplished by addressing the disease's major causes: hepatitis B, hepatitis C, alcohol-associated liver disease and liver disease linked to metabolic risk factors like obesity. With nearly 900,000 new cases globally each year, liver cancer is the sixth most common cancer and the third leading cause of death from cancer. If cases continue to rise at the current rate, the number of new annual diagnoses will almost double, rising to 1.5 million globally in 2050, the study predicted. The researchers estimated that liver disease from alcohol use and metabolic dysfunction together would account for nearly one-third of new liver cancer cases by then. The findings align with what liver specialists have seen in their clinics for years. 'Liver cancer is common, it causes immense suffering and death, and the saddest part for me as a physician is that most of the cases are preventable,' said Dr. Brian P. Lee, an associate professor of medicine at the Keck School of Medicine at the University of Southern California, who was not involved in the study. Improved screening, vaccination and treatment in recent years have helped stem viral hepatitis, especially in the United States. But the threat of liver cancer from heavy alcohol use and metabolic dysfunction-associated steatotic liver disease, or MASLD, formerly known as nonalcoholic fatty liver disease, 'has been underrecognized and underestimated,' said Dr. Ahmed Kaseb, a professor of gastrointestinal medical oncology at the University of Texas MD Anderson Cancer Center, who was not associated with the study. A 'Highway' to Liver Cancer A vast majority of liver cancers arise in people with cirrhosis, said Dr. Hashem El-Serag, the chair of the department of medicine at Baylor College of Medicine in Texas and one of the authors of the new study. Cirrhosis, or advanced and largely irreversible scarring of the liver, damages healthy tissue and prevents the organ from working normally. Want all of The Times? Subscribe.
Medscape
28-05-2025
- Business
- Medscape
Deupirfenidone Shows Promise Against IPF-Linked Lung Decline
SAN FRANCISCO — A molecular variant of an older, hard-to-tolerate antifibrotic agent showed promise for reducing decline in forced vital capacity (FVC) over 26 weeks among patients with idiopathic pulmonary fibrosis (IPF). These findings come from the phase 2B ELEVATE IPF trial, results of which were reported at the American Thoracic Society (ATS) 2025 International Conference here. The trial compared the investigational agent deupirfenidone to placebo for protection against FVC decline in 257 patients with IPF. The deupirfenidone molecule is nearly identical in conformation to pirfenidone, except for the substitution of hydrogen in pirfenidone for deuterium, or 'heavy hydrogen,' in deupirfenidone at the site of metabolism. This process, known as 'deuteration,' is designed to make the modified compound less toxic than pirfenidone, said lead investigator Toby Maher, MD, PhD, from the Keck School of Medicine at the University of Southern California, Los Angeles. Although the primary endpoint of the study was decline in FVC over 26 weeks, 'when we've looked at the open-label extension of patients continuing on the high dose, we've seen a sustained stabilization in FVC over 52 weeks, again suggesting a durable effect of treatment,' he said in an oral abstract session. Multinational Trial In the ELEVATE IPF trial, 257 patients with IPF from 87 sites in 14 countries were enrolled and randomly assigned to one of four treatment arms: 550 mg deupirfenidone thrice per day, 825 mg deupirfenidone thrice per day, 801 mg pirfenidone thrice per day, or placebo thrice per day. The primary Bayesian analysis showed that the mean adjusted change in FVC from baseline to 26 weeks was −48.4 ml for all patients randomized to deupirfenidone compared with −110.7 ml for patients assigned to placebo (posterior probability vs placebo, 98.5%). The respective adjusted mean changes from baseline in FVC% predicted were −48.4% and −1.1% (posterior probability, 99.6%). In a Frequentist inference analysis, compared with placebo the higher dose of deupirfenidone but not the lower dose was associated with significantly less decline in FVC and FVC% predicted. The adjusted mean changes over baseline were −21.5 ml for the 825 mg deupirfenidone group vs −112.5 ml for the placebo group ( P = .02), and the respective changes in FVC% predicted were −21.5% and −3.43% ( P = .01). Both pirfenidone and deupirfenidone 825 mg (but not 550 mg) significantly delayed time to progression compared with placebo. The respective hazard ratios were 0.50 ( P = .0076) and 0.439 ( P = .0033). In the placebo, pirfenidone, deupirfenidone 550 mg and 825 mg arms, respectively, treatment-emergent adverse events commonly associated with antifibrotics were nausea (7.7%, 27.0%, 16.9%, 20.3%), dyspepsia (3.1%, 22.2%, 12.3%, 14.1%), diarrhea (9.2%, 11.1%, 10.8%, 7.8%), abdominal pain (4.6%, 7.9%, 6.2%, 14.1%), photosensitivity reaction (0%, 7.9%, 6.2%, 7.8%), decreased appetite (7.7%, 14.3%, 18.5%, 20.3%), fatigue (1.5%, 11.1%, 7.7%, 9.4%), dizziness (3.1%, 7.9%, 9.2%, 12.5%), and headache (4.6%, 12.7%, 7.7%, 3.1%). GI Signal In the question and answer, session co-moderator Rachel Knipe, MD, from Massachusetts General Hospital in Boston, commented that there appeared to be a small signal for increased abdominal pain with deupirfenidone but less so for diarrhea and other gastrointestinal symptoms. She asked Maher whether investigators had also looked at liver function tests. 'The liver function tests didn't flag up as an adverse event that differed across groups or reached the threshold for inclusion in the table,' Maher said. Maher acknowledged that there are gastrointestinal events associated with the drug, but added that it's difficult to distinguish specific events from one another. 'The challenge with clinical trials in interpreting adverse events is that we are beholden on the individual investigators to label the side effects,' he said, noting that one center's dyspepsia, may be another center's loss of appetite or abdominal pain. In an interview, Medscape Medical News asked Knipe, whose laboratory at Mass General has a special focus on PF, for her impression of deupirfenidone. 'I think the data looks pretty good; it's exciting, and it looks like it has good effect on lung function,' she said, adding that the adverse event profile appears to be more favorable than that of pirfenidone. The study was funded by PureTech Health. Maher reported receiving grants and funding and serving as a consultant for the company and others. Knipe had no disclosures relevant to the study.
