Case 2: Treating Child-Pugh B Metastatic Hepatocellular Carcinoma


A brief review of treatment options for patients with Child-Pugh B grade metastatic hepatocellular carcinoma.

Ghassan K. Abou-Alfa, MD:
I’d like to look at some real-world data, and this is very intriguing. It’s showing that it’s reflective of a nice publication from barely few months ago. It shows that it wouldn’t matter who the patients are, you’ll benefit. However, independent of all of this, I bring up the Child-Pugh B story. Dr Yarchoan, would you have any reflection in regard to Child-Pugh B disease and lenvatinib? What are your thoughts, and how do you measure it or how do you handle it?

Mark Yarchoan, MD: The challenge is that all of our large phase 3 studies are restricted to Child-Pugh A disease, and so many of the patients we see in clinical practice are Child-Pugh B. It’s a shame that we don’t have more clinical data to guide decisions in this population. It’s a real challenge of treating this disease. I think, overall, for Child-Pugh B, this is a group of patients where, at least right now, many of us shy away from combinations like bevacizumab and atezolizumab due to lack of safety data. There was this analysis done of patients in the REFLECT study who started as out as Child-Pugh A but quickly became Child-Pugh B very early in the study. And in that group of patients, lenvatinib appeared to be still reasonably safe and well tolerated. That being said, I think we have more data for sorafenib in Child-Pugh A based on the GIDEON database and then also some data for anti–PD-1 in this group of patients, both retrospectively and prospectively. This is a challenging group of patients for sure.

Ghassan K. Abou-Alfa, MD:I totally agree with you, and you have to remember that the Child-Pugh B is a transitional component. A B7 can be an A6, and A6 can be B7, but when comes to a rock solid B8 to B9, it’s different story. For the A6/B7, I would say yes, exactly as you nicely stated, you can have a bit of a maneuvering component that can help us one way or the other for the therapy.

Transcript edited for clarity.

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