Amit Mahipal, MD

An expert discusses how, for advanced unresectable hepatocellular carcinoma (uHCC), clinicians monitor treatment efficacy through imaging, α-fetoprotein levels, and tolerability. Treatment decisions are guided by response assessment, adverse events, and liver function. First-line (1L) options include tyrosine kinase inhibitors and immunotherapy combinations, with promising trials exploring novel immune combinations and targeted approaches that may reshape the treatment landscape.

An expert discusses how in the first-line (1L) treatment of advanced unresectable hepatocellular carcinoma (uHCC) with tyrosine kinase inhibitors (TKIs) such as lenvatinib or sorafenib, proactive adverse event (AE) management is crucial. This includes baseline assessment; regular monitoring of adverse effects such as hypertension, hand-foot syndrome, and fatigue; and implementing preventive strategies. Treatment should be individualized with dose modifications as needed to balance therapeutic efficacy with quality of life, particularly given the advanced disease state.

An expert discusses how recent analyses from the REFLECT trial in unresectable hepatocellular carcinoma (uHCC) demonstrate that both achieving objective response and greater depth of response correlate with improved survival outcomes. The depth of response serves as a potentially valuable early biomarker for prognosis and treatment decisions, with deeper responses associated with better overall survival among responders.

An expert discusses how treatment selection for first-line (1L) tyrosine kinase inhibitor (TKI) therapy in advanced hepatocellular carcinoma (HCC) requires careful evaluation of multiple factors, including liver function (Child-Pugh status), ECOG performance status, tumor burden, and presence of macrovascular invasion or extrahepatic spread. In reviewing individual cases, clinicians assess liver enzyme levels, α-fetoprotein values, radiographic findings, and comorbidities.

An expert discusses how first-line (1L) systemic therapy for unresectable hepatocellular carcinoma (uHCC) has evolved significantly from sorafenib monotherapy to include combination approaches such as atezolizumab plus bevacizumab, which demonstrated superior outcomes in the IMbrave150 trial. Key challenges include underlying liver dysfunction, heterogeneous tumor biology, and managing adverse events while preserving quality of life. Treatment goals focus on extending survival while maintaining liver function and performance status. The shift toward immunotherapy-based combinations has improved outcomes, though patient selection and sequencing strategies remain important considerations in optimizing first-line treatment decisions in clinical practice.

An expert discusses the patient case of a 57-year-old woman diagnosed with advanced unresectable hepatocellular carcinoma. The patient presented with abdominal pain, fatigue, and loss of appetite. She also has a history of Crohn disease, which is being controlled with infliximab. The patient also has a history of variceal bleeding and has been treated with antiviral therapy for chronic hepatitis B virus infection.