Liver cancer represents one of the main causes of cancer-related death and is considered a major public health problem in Thailand. Due to the limited treatment options and poor prognosis for patients, Chulabhorn Research Institute has been collaborating with Chulabhorn hospital, the National Cancer Institute (Thailand), Khon Kaen University, Chiang Mai University, and the National Cancer Institute (Bethesda, USA). The researcher team has established the Thailand Initiative in Genomics and Expression Research for Liver Cancer (TIGER-LC) with the goal studying two major types of liver cancer in Thailand; hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Since 2008, the consortium has been collecting tissue samples and clinical data from individuals with and without liver cancer to create a comprehensive biorespository for large scale studies.

   The cohort includes 1,000 HCC cases; 2,000 CCA cases, 2,000 patients with chronic liver diseases (high risk non-cancer cases) arising from hepatitis B and or hepatitis C infection, alcoholic cirrhosis, and liver fluke, as well as a sample of 1,000 healthy population-based controls. The hepatocellular carcinoma and cholangiocarcinoma cases and high risk controls are recruited at four hospitals, namely, the Faculty of Medicine at Chiang Mai University, Chulabhorn Hospital, the National Cancer Institute of Thailand, the Faculty of Medicine at Khon Kaen University, over an initial period of 10 years. Since 2010, a biobank has been established to support this research endeavor as well as to facilitate future research. The tumor bank employs a QR code-based specimen tracking system and contains 2 layers of database system for managing the specimen and clinical information.

The main focus of the research is to understand the relationship among genetics, environmental exposures, and the etiology of primary liver cancer through the establishment of a large clinical cohort consisting of well-defined case-control and case-case individuals. Recognizing the molecular features and genetic mutations of liver cancer from Thai patients could lead to more effective treatment options for this population. These findings may point researchers toward new strategies for drug development. Through integrative analysis approaches, the consortium also aims to identify clinically-relevant biomarkers that may be useful for risk assessment, cancer early detection, tumor subtype classification, prediction of tumor relapses and responses to therapy which could potentially lead to more effective treatment of liver cancers.

The TIGER-LC project serves as a rich resource from which numerous investigations can follow, spanning a breadth of disciplines, including genomics, epidemiology, functional and clinical studies. This effort will enhance the scope of our liver cancer knowledge-base and allow us to more successfully manage patient care with an outlook towards precision medicine.