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Exploring Challenges in the Treatment of HCC

Ahmed Omar Kaseb, MD
Published Online:7:22 PM, Mon April 29, 2019

Ahmed Omar Kaseb, MD, associate professor of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, says 2 major challenges in hepatocellular carcinoma (HCC) are the lack of effective treatments and the co-existing underlying chronic liver disease. Not all patients are eligible for surgery or transplant, which can make treatment difficult.

According to Kaseb, only about 10% to 15% of patients with HCC are surgical candidates, and even if they do undergo surgery, some patients will recur. In addition, only about 5% of patients are candidates for liver transplant. The majority of patients are not eligible for surgery or transplant and will require systemic therapy at some point, but that is only palliative and does not downsize the tumors to enable surgery or transplant.

The underlying liver disease poses more risk of higher incidence of side effects in patients with HCC, says Kaseb. Immunotherapy, which carries the promise of being both more effective and more tolerable in this patient population, is now being combined with targeted therapies. Patients with excellent liver condition could also receive combination treatment with chemotherapy or localized therapy. Kaseb concludes that gastrointestinal medical oncologists are trying to take treatment to the next level by incorporating immunotherapy into different lines of therapy with various combination strategies.
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