ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer
Hepatocellular Carcinoma Case Studies

Pierre Gholam, MD: Potential for Systemic Therapy

Pierre Gholam, MD
Published Online:Jun 18, 2015
Steve C is a 56-year-old Caucasian construction worker from Miami, Florida with a history of chronic hepatitis C virus (HCV) infection and alcohol abuse.

Unresectable Hepatocellular Carcinoma: case 2

The BCLC staging system provides a rational approach for classifying patients with HCC from a liver function or severity of liver disease perspective, a functional status perspective, and a cancer staging perspective. The BCLC system not only does that, but it also provides guidelines for what treatment options apply to any particular stage. In the case of a patient who has BCLC class C disease, such as a patient with fairly locally advanced disease with multiple lesions and potential vascular involvement, the recommendation is to apply systemic therapy. In a patient who has BCLC class B disease, there is typically less of a disease burden, so the guidelines recommend therapies such as TACE. The problem with these 2 categories is that there is tremendous heterogeneity and overlap, especially in class B but also in class C.

CASE 2: Unresectable Hepatocellular Carcinoma

Steve C is a 56-year-old Caucasian construction worker from Miami, Florida with a history of chronic hepatitis C virus (HCV) infection and alcohol abuse.

In January of 2013 the patient was diagnosed with unresectable hepatocellular carcinoma, with an encapsulated, 7-cm tumor identified in the right lobe on Gadolinium-enhanced MRI
  • Multidisciplinary team recommended TACE because of patient’s ongoing alcohol use, and patient achieved a partial response (>30% decrease by RECIST criteria)
In April 2014, the patient returns for follow up
  • Patient’s lab values include:
    • AFP: 1100 ng/mL; AST 322 IU/L
    • ALT: 195 IU/L
    • Total bilirubin: 1.8 mg/dL
    • Platelets: 85,000
  • At his current workup, the patient is classified as Child Pugh Class A, with a MELD score of 13; ECOG PS is 1
  • MRI with gadolinium is consistent with disease progression, with encapsulated lesion in the right lobe measuring 9 cm, consistent with HCC
  • A third TACE procedure is recommended by the MDT
Following the TACE procedure, imaging results show 65% necrosis in the treated area with residual 1.5-cm nodules
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