scholarly journals Experience With Changing Etiology and Nontransplant Curative Treatment Modalities for Hepatocellular Carcinoma in a Real-Life Setting—A Retrospective Descriptive Analysis

2021 ◽  
Author(s):  
Suneel Tohra ◽  
Ajay Duseja ◽  
Sunil Taneja ◽  
Naveen Kalra ◽  
Ujjwal Gorsi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Descriptive Analysis ◽  
Real Life ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Real Life Setting

scholarly journals How Much Time Should Be Waited and What Are the Main Findings to Evaluate the Hepatocellular Carcinoma Response to Regorafenib? A Real-Life Experience

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Gustavo Hideki Kawanami ◽  
Leopoldo Katsuda ◽  
Thiara Barcelos Rocha ◽  
Fabio da Silva Yamashiro ◽  
Leonardo Pelafsky ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Kinase Inhibitors ◽  
Life Experience ◽  
Real Life ◽  
Treatment Modalities ◽  
Screening Methods ◽  
Second Line ◽  
Imaging Findings ◽  
Sorafenib Treatment

Background. Hepatocellular carcinoma is a relevant cause of mortality worldwide, mainly among patients who have a prior liver disease. In spite of clear recommendations regarding surveillance and screening methods, most patients are still diagnosed only when they are no longer candidates to curative treatment modalities, while others do not achieve the goals of such treatments, thus increasing the need of anticancer drugs. Moreover, when cirrhotic patients begin to receive these drugs, many types of adverse events are seen as a reason to withdrawal, even when there are findings suggesting a good response to the treatment. Case Summary. This case report is about a cirrhotic patient who received many types of treatment, from surgery and chemoembolization during early stages to first- and second-line systemic therapy when the disease turned to be advanced. Since he had no signs of liver dysfunction and suffered tumor progression during sorafenib treatment, regorafenib was initiated. The main findings that make this case important are the adverse events after taking this second-line agent, which would certainly be considered unacceptable and would lead to the drug withdrawal. The reasons why regorafenib was maintained are explained based on clinical and imaging findings, showing how this decision led to an excellent response. Conclusions. The knowledge of the main adverse events described in the pilot clinical trials can avoid unnecessary withdrawal of regorafenib. In addition, some clinical and imaging findings can be deemed as predictors of good response to tyrosine kinase inhibitors.

scholarly journals Factors predicting long-term outcome of early stage hepatocellular carcinoma after primary curative treatment - the role of surgical or nonsurgical methods

2020 ◽  
Author(s):  
Ming-Jeng Kuo ◽  
Chi-Ling Chen ◽  
Lein-ray Mo
Keyword(s):  
Hepatocellular Carcinoma ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Significant Difference ◽  
Early Hcc ◽  
Time Varying Covariates

Abstract Background The effect of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment, which remains elusive, was quantified. Methods Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) were compared. A polytomous logistic regression was used to estimate factors regarding early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Either match analysis based on propensity score or multiple adjustment regression showed no significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (>= 20 ng/mL), and multinodularity significantly increased risk of early recurrence (<=1year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (>1year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR=1.55, 95% CI:1.01-2.36), clinically significant portal hypertension (CSPH) (HR=1.97, 95% CI:1.26-3.08), early recurrence (HR=6.62, 95% CI:3.79-11.6) and late recurrence (HR=3.75, 95% CI:1.99-7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS comparing to those received RFA with or without TACE. Conclusion Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.

scholarly journals Treatment of Hepatocellular Carcinoma with Immune Checkpoint Inhibitors and Applicability of First-Line Atezolizumab/Bevacizumab in a Real-Life Setting

2021 ◽  
Vol 10 (15) ◽  
pp. 3201
Author(s):  
Maria Corina Plaz Torres ◽  
Quirino Lai ◽  
Fabio Piscaglia ◽  
Eugenio Caturelli ◽  
Giuseppe Cabibbo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Real Life ◽  
Advanced Hepatocellular Carcinoma ◽  
Second Line ◽  
First Line ◽  
Advanced Hcc ◽  
Real Life Setting ◽  
Line Setting

Immune checkpoint inhibitors (ICIs) are the new frontier for the treatment of advanced hepatocellular carcinoma (HCC). Since the first trial with tremelimumab, a cytotoxic T-lymphocyte-associated protein 4 inhibitor, increasing evidence has confirmed that these drugs can significantly extend the survival of patients with advanced hepatocellular carcinoma (HCC). As a matter of fact, the overall survival and objective response rates reported in patients with advanced HCC treated with ICIs are the highest ever reported in the second-line setting and, most recently, the combination of the anti-programmed death ligand protein-1 atezolizumab with bevacizumab—an anti-vascular endothelial growth factor monoclonal antibody—demonstrated superiority to sorafenib in a Phase III randomized clinical trial. Therefore, this regimen has been approved in several countries as first-line treatment for advanced HCC and is soon expected to be widely used in clinical practice. However, despite the promising results of trials exploring ICIs alone or in combination with other agents, there are still some critical issues to deal with to optimize the prognosis of advanced HCC patients. For instance, the actual proportion of patients who are deemed eligible for ICIs in the real-life ranges from 10% to 20% in the first-line setting, and is even lower in the second-line scenario. Moreover, long-term data regarding the safety of ICIs in the population of patients with cirrhosis and impaired liver function are lacking. Lastly, no biomarkers have been identified to predict response, and thus to help clinicians to individually tailor treatment. This review aimed to summarize the state of the art immunotherapy in HCC and, by analyzing a large, multicenter cohort of Italian patients with HCC, to assess the potential applicability of the combination of atezolizumab/bevacizumab in the real-life setting.

scholarly journals Preferred Treatment with Curative Intent for Left Lateral Segment Early Hepatocellular Carcinoma under the Era of Minimal Invasive Surgery

2022 ◽  
Vol 12 (1) ◽  
pp. 79
Author(s):  
Tsung-Han Wu ◽  
Yu-Chao Wang ◽  
Hao-Chien Hung ◽  
Jin-Chiao Lee ◽  
Chia-Ying Wu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Invasive Surgery ◽  
Survival Rates ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Curative Intent ◽  
Lateral Segment ◽  
Left Lateral Segment ◽  
Early Hcc ◽  
Hcc Recurrence

Background: Hepatocellular carcinoma (HCC) occurring at the left lateral segment (LLS) is relatively susceptible to treatment with curative intent in terms of tumor location. However, outcomes might vary depending on the selection of treatment modalities. This study aimed to analyze patients who had undergone curative treatment for early HCC at LLS. Methods: A retrospective analysis of 179 patients who underwent curative treatment for early HCC at LLS was performed. Patients were grouped based on treatment modalities, including radiofrequency ablation (RFA) and liver resection (LR). The long-term outcomes of the two groups were compared. Additionally, the impact of the LR approach on patient outcomes was analyzed. Results: Among these patients, 60 received RFA and 119 underwent LR as primary treatment with curative intent. During follow-up, a significantly higher incidence of HCC recurrence was observed in the RFA group (37/60, 61.7%) than in the LR group (45/119, 37.8%) (p = 0.0025). The median time of HCC recurrence was 10.8 (range: 1.1–60.9 months) and 17.6 (range: 2.4–94.8 months) months in the RFA and LR groups, respectively. In addition, multivariate analysis showed that liver cirrhosis, multiple tumors, and RFA treatment were significant risk factors for HCC recurrence. The 1-, 2-, and 5-year overall survival rates in the RFA and LR groups were 96.4%, 92.2%, and 71.5% versus 97.3%, 93.6%, and 87.7%, respectively. (p = 0.047). Moreover, outcomes related to LR were comparable between laparoscopic and conventional open methods. The 1-, 2-, and 5-year recurrence free survival rates in the laparoscopic (n = 37) and conventional open (n = 82) LR groups were 94.1%, 82.0%, and 66.9% versus 86.1%, 74.6%, and 53.1%, respectively. (p = 0.506) Conclusion: Early HCC at LLS had satisfactory outcomes after curative treatment, in which LR seems to have a superior outcome, as compared to RFA treatment. Moreover, laparoscopic LR could be considered a preferential option in the era of minimally invasive surgery.

scholarly journals Factors predicting long-term outcomes of early-stage hepatocellular carcinoma after primary curative treatment: the role of surgical or nonsurgical methods

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ming-Jeng Kuo ◽  
Lein-Ray Mo ◽  
Chi-Ling Chen
Keyword(s):  
Hepatocellular Carcinoma ◽  
External Validation ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Increased Risk ◽  
Significant Difference ◽  
Early Hcc ◽  
Time Varying Covariates

Abstract Background We quantified the elusive effects of putative factors on the clinical course of early hepatocellular carcinoma (HCC) after primary surgical or nonsurgical curative treatment. Methods Patients with newly diagnosed early HCC who received surgical resection (SR) or percutaneous radiofrequency ablation (RFA) with or without transcatheter arterial chemoembolization (TACE) from January 2003 to December 2016 were enrolled. The cumulative overall survival (OS) and disease-free survival (DFS) rates were compared. A polytomous logistic regression was used to estimate factors for early and late recurrence. Independent predictors of OS were identified using Cox proportional hazard regression. Results One hundred twenty-five patients underwent SR, and 176 patients underwent RFA, of whom 72 were treated with TACE followed by RFA. Neither match analysis based on propensity score nor multiple adjustment regression yielded a significant difference in DFS and OS between the two groups. Multivariate analysis showed high AFP (> 20 ng/mL), and multinodularity significantly increased risk of early recurrence (< 1 year). In contrast, hepatitis B virus, hepatitis C virus and multinodularity were significantly associated with late recurrence (> 1 year). Multivariate Cox regression with recurrent events as time-varying covariates identified older age (HR = 1.55, 95% CI:1.01–2.36), clinically significant portal hypertension (CSPH) (HR = 1.97, 95% CI:1.26–3.08), early recurrence (HR = 6.62, 95% CI:3.79–11.6) and late recurrence (HR = 3.75, 95% CI:1.99–7.08) as independent risk factors of mortality. A simple risk score showed fair calibration and discrimination in early HCC patients after primary curative treatment. In the Barcelona Clinic Liver Cancer (BCLC) stage A subgroup, SR significantly improved DFS compared to RFA with or without TACE. Conclusion Host and tumor factors rather than the initial treatment modalities determine the outcomes of early HCC after primary curative treatment. Statistical models based on recurrence types can predict early HCC prognosis but further external validation is necessary.

Radioembolization for Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Seyda Gunduz ◽  
Gia Saini ◽  
Nicole Segaran ◽  
Sailen Naidu ◽  
Indravadan Patel ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Option ◽  
Early Stage ◽  
Curative Treatment ◽  
Treatment Modalities ◽  
Bridge To Transplantation ◽  
Underlying Liver Disease ◽  
Image Guided ◽  
Advanced Stages

AbstractHepatocellular carcinoma (HCC) is the fastest-growing cancer worldwide, causing significant morbidity and mortality. Surgical resection, ablation, or transplantation is the best treatment option for patients with HCC. However, only about one-fifth of patients are suitable for such primary curative treatments due to underlying liver disease or rapid extension of the tumor. Image-guided locoregional therapies may prove an important alternative in this scenario, particularly transarterial radioembolization (TARE) with yttrium-90 (Y-90). Based on many studies, TARE can be considered a curative treatment option for patients with early-stage HCC, a bridge to transplantation, and a method for downstaging tumors to give patients with unresectable HCC a chance to potentially receive a curative treatment. TARE can be also combined with other treatment modalities to provide a better quality of life in patients when compared with systemic therapy in patients with unresectable HCC. Here, we discuss the use of TARE in the approach to HCC patients who are in early, intermediate, or advanced stages.

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