Amit Singal, MD: Recommendations for Subsequent Monitoring

What are your recommendations for subsequent monitoring in this patient with recurrent uHCC?

When we put someone on sorafenib, we typically will repeat imaging every 3 months while they're on therapy. We do this at our site because we have second-line trials that we could consider placing this patient into if they progress on sorafenib. In centers where they do not have second line trials, there's really nothing else to transition that patient to. There's been nothing that has been shown to be beneficial to non-responders to sorafenib. So you could argue that there's really no reason to monitor that patient in terms of imagine.

CASE 2 : Unresectable Hepatocellular carcinoma (uHCC)

Richard G is a 64-year-old Caucasian night club owner from New Orleans, Louisiana with a history of alcohol and substance abuse, and alcohol-induced cirrhosis.

In April of 2012 the patient was diagnosed with unresectable hepatocellular carcinoma (uHCC), with a 4.6 x 4.3 cm mass detected in segment 6 of cirrhotic liver and evidence of macroscopic vascular invasion and extrahepatic spread to regional lymph nodes

TACE was recommended by the multidisciplinary team and the patient underwent a total of 2 TACE procedures, with a partial response observed (30% decrease in sum of greatest unidimensional diameters of target lesions compared to baseline) by RECIST criteria

In July 2013, follow up laboratory values were:

Albumin: 3.9 g/dL;

Bilirubin: 0.7 mg/dL

Alpha fetoprotein: 53.2 ng/mL

Platelets: 179,000

AST: 370 IU/mL

ALT: 189 IU/mL

The patient is classified as Child Pugh Class A at the current visit, with, with a MELD score of 10, and the patients ECOG performance status is 1

Contrast-enhanced MRI showed disease progression, with increases observed in diameter of multiple target lesions