How can I effectively monitor liver function and tumor markers in patients undergoing treatment for HCC?

Effective monitoring of liver function and tumor markers in patients undergoing treatment for hepatocellular carcinoma (HCC) requires a combined approach integrating regular biochemical liver function tests and serial measurement of specific tumor markers, primarily alpha-fetoprotein (AFP). Liver function should be assessed routinely through standard liver biochemistry panels including bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and albumin, alongside coagulation profiles to evaluate synthetic function, as recommended in UK clinical practice for liver disease management ¹.

In parallel, AFP remains the most widely used tumor marker for HCC monitoring, with elevated levels correlating with tumor burden and treatment response; serial AFP measurements can help detect disease progression or recurrence during and after therapy (Johnson et al., 2022). Additionally, emerging circulating biomarkers and imaging biomarkers are increasingly recognized for their role in monitoring treatment response, but AFP continues to be the cornerstone in routine clinical practice (Cammarota et al., 2022).

Monitoring should be individualized based on treatment modality and disease stage, with more frequent assessments during systemic therapies such as ramucirumab, where AFP levels can also guide treatment safety and efficacy (Yen and Yen, 2022). Imaging modalities, including multiphase CT or MRI, complement biochemical monitoring by providing anatomical and functional assessment of tumor response, but biochemical markers offer a less invasive and more frequent monitoring option (Cammarota et al., 2022).

In summary, effective monitoring integrates regular liver function tests to assess hepatic reserve and toxicity, combined with serial AFP measurements to track tumor dynamics, supported by imaging as clinically indicated. This approach aligns with UK guidelines on liver disease management and is reinforced by recent literature emphasizing AFP’s role and the potential of novel biomarkers in advanced HCC management ¹; (Johnson et al., 2022); (Cammarota et al., 2022); (Yen and Yen, 2022).