Liver Cancer Centre of Excellence

Primary liver cancer is the fastest-rising cause of cancer death in the UK with more than 6,000 people diagnosed every year. It is one of the deadliest forms of cancer, with a ten-year survival chance of less than 10%. The most common type of primary liver cancer is hepatocellular carcinoma (HCC), followed by cholangiocarcinoma – cancer of the bile duct. The liver is also a common site of metastases, for example from the bowel, where only a small proportion of tumours can be surgically removed.

Clinical Researchers play crucial roles in all stages of liver cancer patient care meaning that effective innovation is rapidly implemented for Oxford patients.

The Oxford Liver Cancer Centre of Excellence

To ensure we prioritise what really matters to patients, this strategy is being developed in collaboration with our purposefully built patients and public involvement. The Centre of Excellence builds on existing Oxford-led studies such as:

-          DeLIVER: collecting samples from over 3,000 patients with pre-cancerous or early liver cancer to inform new technologies for early HCC detection;

-          AMULET: optimising MRI techniques for early liver cancer detection;

-          COMBATcancer: identifying novel features across cancers and related inflammatory conditions to generate earlier diagnosis tools and new treatment options. 

The centre's priorities can be divided into three themes, each outlined below. Data will be integrated and made accessible to the community through the Translational Data Platform led by Andy Blake.

New diagnostic tools for early detection

Diagnosing cancer at the earliest possible stage when it is more easily curable represents a significant opportunity for improving survival. Our flagship project CELESTE (link to page) will provide an in-depth understanding of how normal tissue transforms to become cancerous, uncovering new opportunities to prevent, detect and treat liver cancer.

In the hope of developing non-invasive cancer diagnostic technologies (blood tests or clinical imaging) that GPs can use, we will leverage the ongoing UK-wide longitudinal DeLIVER programme which is tracking patients with cirrhosis who are at high-risk of developing liver cancer. In the Pearl arm of the study, 3,000 high-risk patients will be followed for four years with annual sampling, imaging and collection of clinical data. The parallel SELiNa arm, will use novel imaging techniques to detect early signs of cancer in >200 patients. Thanks to an NIHR-funded Oxford BRC project, the Liver Cancer Centre of Excellence will also be able to rely on samples from a cohort of patients at high risk of cholangiocarcinoma.

New/more effective immunotherapies

Despite immunotherapy in liver cancer showing encouraging results, only about 30% of patients with HCC respond. We will apply our world-leading immunology expertise to study why some people benefit from it whilst others don’t, and how we can develop more effective immunotherapies that can be tested in our early-phase clinical trial units (OCTO, EPCTU). 

We will use the DELPHI arm of the DeLIVER trial to uncover 1) tumour-specific characteristics (or ‘antigens’) that we can target, 2) which tumour-reactive killer T cells recognise these antigens so that we can exploit them, and 3) whether the parallel use of hypoxia-inducible factors (HIF) inhibitors can improve efficacy.

Better disease models

Given the diversity of liver cancers among patients, the development of novel disease models is crucial to understanding the patient-specific response to therapy. We are using OrganOx, a perfusion system that allows human organs to survive out of the body for hours or days to study the biology and treatment response of cancerous livers following their surgical removal from patients. This highly novel model system recapitulates physiological drug delivery and models diversity, making it easier and safer to trial novel therapies.