Breakthrough in Liver Cancer Detection: The ALTUS Trial's Implications for Clinical Practice

The ALTUS trial reports a clinically meaningful advance in surveillance: a blood-based assay materially improves detection of very early hepatocellular carcinoma (HCC), with immediate relevance for clinicians who manage high-risk patients.

Per the sponsor's press release, ALTUS was a prospective, head-to-head trial enrolling roughly 3,000 participants across community clinics, Veterans Affairs centers, and academic sites and focused on individuals at high risk for HCC. The primary endpoints prioritized sensitivity for very early-stage HCC and overall early-stage detection to assess real-world surveillance performance.

The release states the blood assay showed a sevenfold higher sensitivity for very early-stage HCC compared with ultrasound—an improvement that, if confirmed in peer-reviewed data, could substantially increase detection when curative options remain possible. Reported specificity remained clinically useful. Compared with ultrasound's known limitations—reduced sensitivity for small lesions and in patients with obesity—the Oncoguard Liver test demonstrated markedly higher detection of very small, treatment-eligible tumors, which in turn creates more opportunities for curative-intent therapies, including resection and transplant evaluation.

Importantly, the ALTUS cohort included a racially and ethnically diverse population, strengthening external validity and supporting broader applicability across groups historically underrepresented in surveillance studies. That said, practical barriers remain: test availability, laboratory turnaround time, integration into electronic workflows, and defined imaging and referral pathways for positive results must be resolved before widescale adoption. Implementation planning will determine how quickly earlier detection translates into improved clinical outcomes.