Please login or register first to view this content.
Decisions in the Clinic: Treating Patients With Hepatocellular Carcinoma |
Practice Community
Phoenix, AZ
Practice Niche
Oncology/Hematology
Hospital and Institutional Affiliations
Oncologist
Mayo Clinic Cancer Center
Question After a patient is diagnosed with hepatocellular carcinoma (HCC), what are the first treatment options you consider? What are the key patient factors that influence your decision making? |
Answer Patients with HCC, unlike some other patients with cancer, need a multidisciplinary approach when making decisions about initial treatment and prognostic communication. The spectrum of treatments that can be employed is quite wide. If eligible, the patient could be considered for curative procedures such as surgery or transplant. Discerning which patients may be suitable candidates for those treatments is not a trivial matter and is best done through proper engagement with colleagues in surgery and transplant, hepatology, and, of course, colleagues who are experts in local-regional therapies such as interventional radiologists or radiation oncologists. |
Question What is the role of molecular profiling in HCC management? In what ways can it be useful to have a tissue diagnosis for patients? |
Answer I use molecular profiling on my end, but in the context of research. There are no approved [targeted] therapies per se for HCC, where you would use the molecular profiling to select patients for therapies. |
Question What research from the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting did you find to be most relevant to treating patients with hepatocellular carcinoma? |
Answer Amongst the notable data presented were phase 2 data for the immune checkpoint inhibitor pembrolizumab, which was consistent with prior data using nivolumab with an approximately 20% response rate, with many of these responses being durable.1 In a phase 3 study, ramucirumab, which is an antibody against VEGFR2, showed survival benefit in alpha-fetoprotein-high patients.2 Lastly, a combination of atezolizumab with bevacizumab was one in which people saw some promise.3 This represents 1 of the first efforts combining an antiangiogenic agent with an immune checkpoint inhibitor. I envision a lot more activity using this concept with the various available agents from both categories. |
Question How might the data on agents like cabozantinib (eg, from the CELESTIAL trial), lenvatinib (REFLECT trial), and ramucirumab (REACH-2) change your decision making for patients? |
Answer I mentioned ramucirumab. Cabozantinib showed survival advantage in the second- and third-line and is another option in that space.4 Similarly, lenvatinib showed noninferiority to sorafenib, and provides another option in the first-line space.5 I don’t think these represent tremendous advantages, but they are certainly additional tools for physicians to use for these patients. |
Question Are there any ongoing clinical trials you would recommend for patients with advanced, unresectable HCC? |
Answer There is a wide array of studies of immune checkpoint inhibitors being conducted. Any of those studies would be highly pertinent for consideration. |