Ruth He, MD, grants advice on how to treat patients with unresectable hepatocellular carcinoma.
Ruth He, MD: To optimize patients’ treatment, we need to start patients on treatment when appropriate, ideally prior to liver decompensation when patients still have Child-Pugh A liver function. For patients who are receiving locoregional therapy, they should be monitored closely. Additionally, if those patients show signs of refractory disease to locoregional therapy, they should be transitioned to systemic therapy. For patients who are symptomatic from their cancer and have extrahepatic spreading or vascular invasion into portal vein or branch of the portal vein, the patient should be considered an advanced-stage patient and should be transitioned to systemic therapy.
When we start a patient on systemic therapy, we need to evaluate the liver function carefully. Before we start a patient on systemic therapy, I would assess the patient’s liver function. Moreover, I would refer the patient to GI [gastrointestinal] or hepatology for an endoscopy to evaluate and treat varices in patients with cirrhosis.
HCC [hepatocellular carcinoma] is a cancer with underlying liver disease of different etiologies, which make it quite complicated. However, studies have shown patient care under the multidisciplinary approach has better outcomes compared with care provided by a single specialty. As such, I highly recommend that our patients be cared for by a multidisciplinary team.
Transcript edited for clarity.