What are your recommendations for subsequent monitoring in this patient with recurrent uHCC?
So this patient has undergone two cycles of chemoembolization procedures and, at this time, has evidence of progression within the liver as well as outside the liver. Treatment options will include systemic treatment at this time or for this patient who has already undergone chemoembolization, perhaps they would consider chemoembolization number 3, given that there’s been progression in the liver.
I don’t see that there would be a role for that at this time or for that matter, radioembolization. I think at the time of progression outside of the liver, as well as with portal vein thrombosis, that this patient is beyond treatment with local regional therapy, whether it be Y-90 or chemoembolization and should be considered for a systemic treatment option.
CASE 2 : Unresectable Hepatocellular carcinoma (uHCC)
Richard G is a 64-year-old Caucasian night club owner from New Orleans, Louisiana with a history of alcohol and substance abuse, and alcohol-induced cirrhosis.
In April of 2012 the patient was diagnosed with unresectable hepatocellular carcinoma (uHCC), with a 4.6 x 4.3 cm mass detected in segment 6 of cirrhotic liver and evidence of macroscopic vascular invasion and extrahepatic spread to regional lymph nodes
TACE was recommended by the multidisciplinary team and the patient underwent a total of 2 TACE procedures, with a partial response observed (30% decrease in sum of greatest unidimensional diameters of target lesions compared to baseline) by RECIST criteria
In July 2013, follow up laboratory values were:
Albumin: 3.9 g/dL;
Bilirubin: 0.7 mg/dL
Alpha fetoprotein: 53.2 ng/mL
Platelets: 179,000
AST: 370 IU/mL
ALT: 189 IU/mL
The patient is classified as Child Pugh Class A at the current visit, with, with a MELD score of 10, and the patients ECOG performance status is 1
Contrast-enhanced MRI showed disease progression, with increases observed in diameter of multiple target lesions
Gholam Analyzes Treatment Outcomes for Advanced HCC in Child-Pugh B Population
April 28th 2024During a live Community Case Forum event in partnership with the Tennessee Oncology Practice Society, Pierre Gholam, MD, examined the current state of treatment for patients with hepatocellular carcinoma, looking in particular at what data is available for those with Child-Pugh B and C status who have poorer outcomes and have limited data from prospective clinical trials.
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