Unresectable Hepatocellular carcinoma with Amit Singal, MD and Richard Finn, MD: Case 2

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