61-Year-Old Man With Stage IV Hepatocellular Carcinoma

Patient Prognosis of Metastatic HCC

Multidisciplinary Management and Diagnostic Work-up of HCC

Frontline Treatment in HCC: Systemic vs Locoregional Therapy

Advanced HCC: IMbrave150 Trial

Approaching Second-Line Therapy for Advanced HCC

Advanced HCC: CELESTIAL Trial

Future Treatment Landscape for Advanced HCC

Case: A 61-Year-Old Man with Stage 4 Hepatocellular Carcinoma

A 61-year-old man presented with nausea, vomiting, decreased appetite and occasional generalized itching

PMH: diabetes, medially controlled; hepatitis C and B coinfection diagnosed and treated 6 years ago; diagnosed with HCC December 2018

PE: scleral icterus; jaundice; spleen palpable 4-cm below the costal margin



Labs: AFP 436 ng/mL, bilirubin 1.6 mg/dL, AST 105 U/L, ALT 110 U/L, ALP 390 U/L, INR 1.9, albumin 3.8 g/dL, BUN 13 mg/dL, creatinine 1 mg/dL, plt 95,000

Abdominal ultrasound revealed 3 small hepatic lesions

Chest/abdominal/pelvic CT scan confirmed 2 focal nodules in the right and 1 in the left hepatic lobe measuring 3.6 cm, 4.9 cm and 5.2 cm, a suspicious lesion in the right lower lung lobe; wide-spread lymphadenopathy was noted

Biopsy findings showed grade 3 hepatocellular carcinoma with marked fibrosis

Surgical consult: unresectable due to tumor size and location

2018: treated with lenvatinib 400 mg PO q12hr; he experienced diarrhea for 2 weeks which resolved; achieved PR

Treatment was with cabozantinib 60 mg PO qDay was initiated

Case Based Peer Perspectives

Pierre Gholam, MD, provides insight on the case of a 61-year-old man with stage 4 hepatocellular carcinoma and evaluates current treatment options on TKIs.