OMATA教授访谈

Masao Omata  University of Tokyo， Japan

Hepatology Digest: As a past president of APASL， what are some of the biggest highlights of this year’s annual APASL meeting?

Prof. Omata: APASL is mainly dealing with liver disease， which is very common in Asia. In that context the treatment of the hepatitis B virus is in full swing now. We are now able to talk about not just suppression of the virus， but how we can eliminate the disease itself.

Hepatology Digest:  Obviously， you want to educate physicians， but how about raising public awareness of hepatitis? Is that part of the mission?

Prof. Omata: In the general context， because of APASL， especially at the meetings held in Seoul and Japan and also the previous one in Bali， for the last five years there has been a large attendance. It used to only have a 300~500 person attendance but the Kyoto meeting was 3，000 and the Seoul meeting was 2，900， which was a very large attendance. That means that education in terms of the medical society， it is going to be a key for the audience to be there and also we really need ordinary education for the general population and then we may have some improvement.

Hepatology Digest: In your opinion， what is the biggest problem of chronic HBV patient management in Asia?

Prof. Omata: Now there are several very good drugs available. I think one problem right now is the cost of drug in many Asian countries. The second question， unfortunately the treatment of hepatitis B is not a cure， but just the suppression of the virus. So I think we have to really study hard to find a way to cure this virus.

Hepatology Digest: Is the hepatitis B roadmap concept widely used in the treatment of chronic HBV patients in Japan? Do you think that the hepatitis B roadmap concept should be adjusted because of the new anti-HBV drugs?

Prof. Omata: I think that certainly roadmap concept  is a really catchy phrase for a lot of people， so in that context it has a lot of impact. Also you must understand how you can measure the virus itself. So， the combination of the two parts of actually measuring the virus and the catchy phrase impact I think encourages us to discuss a lot. However， in a practical sense， if you ask whether it is really used as a guideline for us to give treatment， then the answer is no in Japan. Japan is an exceptional situation. We only have a choice of 2~3 drugs-lamivudine， adefovir， and entecavir， but not telbivudine or other drugs. So， I think that the roadmap concept is not as influential in Japan as in other parts of Asia.

Hepatology Digest: I would assume that different economic conditions in different parts of Asia would influence the approach taken as well?

Prof. Omata: I think lamivudine is relatively economical in that context. Many countries try to use lamivudine as a first-line drug， but lamivudine has the highest mutation rate. Japanese cases got started lamivudine plus adefovir， which is very expensive because somehow in Japan adefovir is the most expensive drug; therefore a lot of people are switching to entecavir. We don’t have telbivudine or tenofovir yet. Among those three drugs， it seems like that the first-line drug is now becoming entecavir. I know that entecavir is still expensive in many Asian countries， but because of the exceptional situation in Japan where adefovir is expensive， the adefovir and lamivudine combination is becoming more and more expensive so that is why entecavir has a certain market share because of the prices.

Hepatology Digest: HCV and HBV induced hepatocellular carcinoma is a major health problem in Asia. What strategies can be used in the next decade to minimize the damage caused by HBV/HCV virus induced HCC?

Prof. Omata: That is a major purpose for us to try to encourage APASL because we may have a lot of patients with hepatocellular carcinoma in the next ten years. I think that we have to assess who will really get cancer in five to ten years. We have to really validate and prove the treatment really reduces the cancers. In hepatitis C patients it is about eradicating and clearing the virus， which has been demonstrated in many studies maybe ten years ago. Regarding the hepatitis B virus， there is data in the New England Journal of Medicine showing that lamivudine did reduce hepatocellular carcinoma and other complications， but that is only one study. There were several drawbacks in the study， like stopping treatment because of possible mutations. There are some discussions about continuing further study for perhaps five years， but there really isn’t evidence so far. I think we need some solid evidence to say that if a patient takes a drug for maybe five years can reduce the incidence of cancer.

Hepatology Digest: Novel candidate HCC diagnosis markers have been identified in recent years due to the wide use of high-throughput genomic and proteomic technologies in HCC research. What do you think of the clinical value of these candidate markers? Are there any new serum markers already available for clinical use?

Prof. Omata: I have been doing these studies for more than 20 years. I started my molecular biologic studies in 1982. I don’t think those molecular markers are going to change clinical practice because we have so many very useful markers already and it is a very expensive clinical tool. It is ok to publish papers but I am not sure if it can change clinical practice. We may need one or two more decades to say it is useful. It has to have a lot of clinical indications if you to really employ it.