During a live event, Rushang Patel, MD, PhD, and participants discussed referral timing, bridging, and payer barriers that shape access to cellular therapy in early relapsed multiple myeloma.
|Videos|September 9, 2019
Optimal Management of Relapsed/Refractory mHCC
Optimal Management of Relapsed/Refractory mHCC
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Case: 63-Year-Old Male with R/R mHCC
February 2018: Initial presentation
- A 63-year-old man with chronic HBV infection referred for further imaging studies based on suspicious findings during routine ultrasound for HCC
Initial Clinical Workup
- AFP: 300 IU/mL
- Child-Pugh A
- Platelets: 210,000 cells/mcL
- Bilirubin: 1.2 mg/dL
- Albumin: 3.6 g/dL
- INR: 1.1
- No hepatic encephalopathy
- Ascites not present
- Imaging: CT revealed 2 lesions in right hepatic lobe (2cm, 5cm); no extrahepatic disease; no cirrhosis; no portal hypertension
- BCLC: B
- PS: 0
Treatment
- Patient underwent right hepatectomy; negative margins; no vascular invasion
- AFP: WNL
December 2018
- On routine follow-up, imaging showed new lesion in left hepatic lobe (~2.3cm)
- Chest CT showed 3 small lesions (<1cm) in upper left lobe of lung
- Patient started on lenvatinib 12 mg QD; experienced moderate diarrhea and fatigue
- Imaging at 3 and 6 months showed partial response
- AFP: 100 IU/mL
- BCLC: C
- PS: 0
August 2019
- Routine follow-up blood sample reveals AFP 450 IU/mL
- CT scan showed progression in the lung and 2 new liver lesions; remains Child-Pugh A
- Patient started on cabozantinib 60 mg QD
- Patient developed grade 2 diarrhea; dose-reduction to 40 mg QD
- Imaging at 3 months showed stable disease
- Imaging at 6 months showed partial response
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