A 61-Year-Old Woman With Hepatocellular Carcinoma - Episode 2

Unresectable HCC: Case Prognosis and Impressions

Dr Gholam, MD, provides expert analysis on the prognosis and treatment of a patient with unresectable HCC.

Pierre Gholam, MD: Patients with unresectable HCC [hepatocellular carcinoma], up until not very long ago, faced a fairly daunting prospect when it came to prognosis. The prognosis of untreated, unresectable HCC is well documented to be typically well under a year in terms of overall survival. But we’ve made tremendous progress, especially in the last 5 years, in terms [of what we are] able to offer these patients. Especially if they have Child-Pugh A cirrhosis, [we have] treatments that can not only extend life up to an overall survival of around 20 months at this point, I think one could reliably say, but also [could] potentially halt the decline in quality of life, which these patients experience fairly rapidly. While this person does not have, with our current treatment options, the ability to be cured of HCC, she certainly has viable treatment options that can potentially help increase life and extend quality of life.

Transcript edited for clarity.

A 61-Year-Old Woman with Hepatocellular Carcinoma

Initial Presentation

  • A 61-year-old woman complains of fatigue, RUQ pain and nausea and vomiting
  • PMH: medically controlled hypertension; obesity; diabetes managed with oral medication
  • PE: hepatomegaly with tenderness over the RUQ

Clinical Workup

  • CT scan of chest, abdomen and pelvis, with 4 phase liver evaluation: 4.0-cm hepatic mass in the right hepatic lobe
  • Labs: AFP: 1.5 ng/dL; Alb: 3.9 g/dL; INR: 1.45; Bili: 1.1 mg/dL , HbA1c: 7.0; platelet count 90,000
  • Biopsy of the lung metastasis demonstrated evident hepatocellular carcinoma
  • Child-Pugh A
  • ECOG PS 1

Treatment

  • Initiated lenvatinib 12 mg QD