Richard Finn, MD: Recommendations for Subsequent Monitoring

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

So this patient has undergone two cycles of chemoembolization procedures and, at this time, has evidence of progression within the liver as well as outside the liver. Treatment options will include systemic treatment at this time or for this patient who has already undergone chemoembolization, perhaps they would consider chemoembolization number 3, given that there’s been progression in the liver.

I don’t see that there would be a role for that at this time or for that matter, radioembolization. I think at the time of progression outside of the liver, as well as with portal vein thrombosis, that this patient is beyond treatment with local regional therapy, whether it be Y-90 or chemoembolization and should be considered for a systemic treatment option.

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