Unresectable Hepatocellular Carcinoma: case 2 - Episode 4

Nicholas Nissen, MD: Potential for Systemic Therapy

June 18, 2015

potential for systemic therapy is good. Systemic therapy should be considered after second TACE if there is residual disease.

Dr. Nissen believes the


CASE 2: Unresectable Hepatocellular Carcinoma

Steve C is a 56-year-old Caucasian construction worker from Miami, Florida with a history of chronic hepatitis C virus (HCV) infection and alcohol abuse.

In January of 2013 the patient was diagnosed with unresectable hepatocellular carcinoma, with an encapsulated, 7-cm tumor identified in the right lobe on Gadolinium-enhanced MRI

Multidisciplinary team recommended TACE because of patient’s ongoing alcohol use, and patient achieved a partial response (>30% decrease by RECIST criteria)

In April 2014, the patient returns for follow up

Patient’s lab values include:

AFP: 1100 ng/mL; AST 322 IU/L

ALT: 195 IU/L

Total bilirubin: 1.8 mg/dL

Platelets: 85,000

At his current workup, the patient is classified as Child Pugh Class A, with a MELD score of 13; ECOG PS is 1

MRI with gadolinium is consistent with disease progression, with encapsulated lesion in the right lobe measuring 9 cm, consistent with HCC

A third TACE procedure is recommended by the MDT

Following the TACE procedure, imaging results show 65% necrosis in the treated area with residual 1.5-cm nodules