Blood-Based Surveillance in Liver Cancer: Insights from the ALTUS Trial

The ALTUS trial demonstrates that a multi-target blood test detects more early-stage hepatocellular carcinoma than traditional ultrasound—findings that could shift surveillance practice and increase opportunities for curative treatment.

In a large, prospective head-to-head cohort, investigators compared the blood-based assay directly with ultrasound for the endpoint of early-stage HCC detection. The head-to-head design strengthens applicability to routine surveillance and supports the credibility of the reported performance difference.

Per the company press release, the multi-target Oncoguard Liver test showed higher sensitivity for early-stage HCC than ultrasound, yielding greater early-case detection; if these results are confirmed in primary data, earlier detection may increase the number of patients eligible for potentially curative interventions.

The assay is multi-target, combining complementary classes of circulating tumor-associated signals. Multi-modal liver-cancer tests commonly integrate DNA methylation and protein biomarkers; this combination plausibly accounts for the improved sensitivity observed in the trial.

Blood-based surveillance could improve access and equity through greater scalability, less operator dependence, and simpler logistics for decentralized care. Key implementation caveats include cost, workflow integration, and the need for confirmatory imaging after a positive blood test.

Overall, blood-based testing presents a practical pathway to expand surveillance to underserved populations. Looking ahead, implementation studies and guideline integration will be the field’s next priorities.

Key Takeaways:

• A prospectively validated multi-target blood test detected more early-stage HCC than ultrasound in head-to-head testing—suggesting a potential new surveillance benchmark.
• Patients at high risk for HCC, particularly those with limited access to high-quality imaging, may benefit from earlier detection and expanded treatment options.
• Next steps include independent review of primary data, prospective implementation studies, pathways for confirmatory imaging, and consideration by guideline committees.