Amit Singal, MD

Amit Singal, MD, medical director of the Liver Tumor Program and clinical chief of hepatology at the University of Texas Southwestern Medical Center, discusses options after surgical resection for patients with hepatocellular carcinoma (HCC).

Surgical resection is the treatment available to patients with HCC who are eligible. After resection, there is still remnant cirrhotic liver, and patients have recurrent disease 50% to 70% of the time within 5 years after surgery, according to Singal. Patients need to be followed closely after surgical resection with routine CT or MRI scans at 3- to 6-month intervals.

Adjuvant therapy has been a point of interest in the HCC setting, including tyrosine kinase inhibitors (TKIs), which have been investigated for efficacy. Singal says the most notable is adjuvant sorafenib (Nexavar) used after surgical resection in the STORM trial (NCT00692770). Although there was excitement for using TKIs in HCC, the sorafenib trial data were negative.

However, Singal says immune checkpoint inhibitors (ICIs) have revolutionized the approach to advance-stage HCC. This includes regimens like atezolizumab (Tecentriq) and bevacizumab (Avastin), which is now the standard of care for these patients. Other ICIs are now being evaluated in clinical trials in earlier stages of HCC as neoadjuvant and adjuvant therapy. Signal thinks this is exciting even though it’s still in early stages of trials.

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Amit Singal, MD, discusses options after surgical resection for patients with hepatocellular carcinoma.

Investigators Are Exploring Neoadjuvant and Adjuvant Therapy in HCC

Amit Singal, MD, medical director of the Liver Cancer Program at UT Southwestern Medical Center, discusses the current treatment landscape for patients with hepatocellular carcinoma (HCC) and how the treatments differ among patients diagnosed in the early stage versus late stage at the 2019 International Liver Cancer Association Annual Conference.

For patients with HCC where the disease is caught at an early stage, curative options are available, Singal says. These therapies include surgical resection of the liver, local ablation, and liver transplantation. These treatments can afford a 5-year survival in over 60% of patients.

However, Singal notes that patients with disease found at a more intermediate or advanced stage have different treatment options, including palliative therapies such as chemoembolization, radioembolization, radiation-based therapies, or systemic therapies, like tyrosine kinase inhibitors.

Amit Singal, MD, discusses the current treatment landscape for patients with hepatocellular carcinoma and how the treatments differ among patients caught in early-stage versus late-stage at the 2019 International Liver Cancer Association Annual Conference.

Amit Singal, MD | Authors

Articles

Investigators Are Exploring Neoadjuvant and Adjuvant Therapy in HCC

Curative and Palliative Treatment Options for Patients With Hepatocellular Carcinoma