A survey of US veterans with non-muscle invasive bladder cancer identifies barriers to treatment access, care coordination challenges, and gaps in patient education.
|Videos|June 5, 2020
A 69-Year-Old Man With Stage 4 Hepatocellular Carcinoma
Author(s)Anthony El-Khoueiry, MD
Anthony El-Khoueiry, MD, provides insight on the case of a 69-year-old man with stage 4 hepatocellular carcinoma and evaluates current and emerging treatment options.
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Case: A 69-Year-Old Man with Stage 4 Hepatocellular Carcinoma
Initial presentation
- A 69-year-old man presented with vague right upper quadrant abdominal discomfort, decreased appetite and occasional nausea and vomiting
- PMH: diabetes, medially controlled; hepatitis B virus diagnosed and treated 8 years ago
- SH: moderate amount of alcohol use (2-3 drinks a day)
- PE: abdominal discomfort on palpation
Clinical workup
- Labs: AFP 425 ng/mL, bilirubin 1.2 mg/dL, AST 102 U/L, ALT 116 U/L, ALP 380 U/L, INR 1.6, albumin 3.6 g/dL, BUN 15 mg/dL, creatinine 1.5 mg/dL, plt 205,000
- HBV+, HCV-
- Abdominal ultrasound revealed 2 hepatic lesions
- Chest/abdominal/pelvic CT scan confirmed 2 lesions in the right hepatic lobe measuring 3.2 cm and 5.5 cm, a suspicious lesion in the left lung lobe, and wide-spread lymphadenopathy noted
- Biopsy findings showed grade 3 HCC with marked fibrosis
- Surgical consult: unresectable due to tumor size and location
- Child-Pugh A; BCLC stage C
- ECOG 1
Treatment and Follow-Up
- Treatment with atezolizumab + bevacizumab was initiated
- First imaging shows stable disease at 2 months; imaging at 4-month follow-up showed 2 new lung lesions
- Treatment was subsequently changed to cabozantinib 60 mg PO qDay
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