Ramucirumab in patients with advanced hepatocellular carcinoma and elevated alpha‐fetoprotein: outcomes by treatment‐emergent ascites

Traditionally, liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis is not recommended. However, with recent developments in locoregional therapies for hepatocellular carcinoma, more aggressive treatments have been attempted for advanced hepatocellular carcinoma. Recently, various studies on locoregional therapies for downstaging followed by living donor liver transplantation reported inspiring overall survival and recurrence-free survival of patients. These downstaging procedures included three-dimensional conformal radiation therapy, trans-arterial chemoembolization, stereotactic body radiation therapy, trans-arterial radioembolization, hepatic arterial infusion chemotherapy and combinations of these therapies. Selection of the optimal downstaging protocol should depend on tumor location, biology and background liver status. The risk factors affecting outcome include pre-downstaging alpha-fetoprotein values, delta alpha-fetoprotein values, disappearance of portal vein tumor thrombosis on imaging and meeting the Milan criteria or not after downstaging. For hepatocellular carcinoma with portal vein tumor thrombosis, downstaging procedure with liver transplantation in mind would be helpful. If the reaction of the downstaged tumor is good, liver transplantation may be performed.

Download Full-text

GS-09-Ramucirumab for patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein following sorafenib: Outcomes by liver disease aetiology from two randomised, placebo-controlled phase 3 studies (REACH-2 and REACH)

Journal of Hepatology ◽

10.1016/s0618-8278(19)30081-7 ◽

2019 ◽

Vol 70 (1) ◽

pp. e46 ◽

Cited By ~ 3

Author(s):

Peter Galle ◽

Masatoshi Kudo ◽

Josep M. Llovet ◽

Richard Finn ◽

Mark Karwal ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Disease ◽

Alpha Fetoprotein ◽

Advanced Hepatocellular Carcinoma ◽

Phase 3 ◽

Disease Aetiology

Download Full-text

Liver Damage after Transarterial Chemoembolization without Embolizing Agent in Unresectable Hepatocellular Carcinoma

Tumori Journal ◽

10.1177/030089160308900310 ◽

2003 ◽

Vol 89 (3) ◽

pp. 285-287 ◽

Cited By ~ 4

Author(s):

Stefano Puleo ◽

Letizia Mauro ◽

Giuseppe Gagliano ◽

Rosario Lombardo ◽

Giovanni Li Destri ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Transarterial Chemoembolization ◽

Alpha Fetoprotein ◽

Total Serum ◽

Advanced Hepatocellular Carcinoma ◽

Significant Finding ◽

Safe Procedure ◽

Hepatic Functional Reserve ◽

Neoplastic Tissue ◽

Functional Reserve

Aim and Background Transarterial chemoembolization represents a therapy for hepatocellular carcinoma, but in cirrhotic patients affected by large or multifocal HCC with poor hepatic functional reserve, the procedure can damage normal parenchyma. We analyzed the effects on hepatic function of a modified chemoembolization consisting of ethiodized oil (Lipiodol Ultra Fluid) and epirubicin without gelatine sponge (C-LIP). Methods Of 90 patients with hepatocellular carcinoma observed from January 1995 to December 1999, 16 with a diagnosis of advanced (large or multifocal) disease underwent 19 C-LIP. The 30th post-C-LIP day was considered as a checkpoint of the biochemical parameters for a possible hepatic failure. The value of alpha-fetoprotein and the clinical finding of ascites were also considered after 30 days. Results Postoperative values of serum aspartate aminotrasferases, as well as alanine aminotransferase, were significantly higher than preoperative values (P = 0.002 and P = 0.019, respectively) (Table 1). In all patients, there was a significant increase in postoperative total serum bilirubin (P = 0.003). Statistical analysis showed a significant finding of postoperative ascites (P = 0.035) and the effectiveness of C-LIP on neoplastic tissue by a decrease of alpha-fetoprotein values at 30 days (P = 0.067). Conclusions Transcatether arterial chemoembolization could represent an effective therapy against multifocal or advanced hepatocellular carcinoma, and its effectiveness is probably not decreased by using a modified procedure without embolizing agent (C-LIP). However, even when performing such a safe procedure, the hepatic functional reserve of the individual patient needs to be accurately evaluated in order to avoid liver failure.

Download Full-text