scholarly journals BCLC-B hepatocellular carcinoma treatment or when should the systemic therapy be started

2018 ◽  
pp. 27-32
Author(s):  
V. V. Breder ◽  
M. U. Pitkevich ◽  
E. R. Virshke ◽  
L. A. Kostyakova ◽  
I. A. Dzhanyan ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Systemic Treatment ◽  
Clinical Problem ◽  
Clinical Heterogeneity ◽  
Practical Application ◽  
Transarterial Chemoembolisation ◽  
Advanced Hcc ◽  
Significant Survival

Choice of the optimal therapy for BCLC-B hepatocellular carcinoma (HCC) is a significant clinical problem. Transarterial chemoembolisation (TACE) is considered to be the method of choice as this approach is reported to produce a direct effect and to have a significant survival rate. However, TACE is not always applicable and produce a survival benefit due to the clinical heterogeneity of BCLC-B HCC. The article includes different approaches for BCLC-B HCC patients, TACE prediction and refractory criteria as well as the results obtained. The necessity of timely sorafenib systemic therapy in BCLC-B and in advanced HCC after TACE is discussed. Practical application of regorafenib as the second line in HCC systemic treatment is discussed.

Embolization versus embolization and systemic therapy in patients with hepatocellular carcinoma and metastatic disease: A retrospective analysis.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 363-363 ◽  
Author(s):  
Sunnie Kim ◽  
Karen T. Brown ◽  
Yuman Fong ◽  
Stephen Barnett Solomon ◽  
Joanne F. Chou ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Retrospective Analysis ◽  
Systemic Therapy ◽  
Survival Benefit ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Arterial Embolization ◽  
Combined Modality ◽  
Kaplan Meier

363 Background: Transarterial chemoembolization (TACE) provides a survival benefit in a subset of patients with unresectable hepatocellular carcinoma (HCC). Even though data are lacking, patients with metastatic HCC (mHCC) are sometimes treated with transarterial therapies to address the hepatic disease. Sorafenib is a standard treatment for patients with mHCC. Methods: A retrospective analysis was conducted on patients diagnosed with HCC who had undergone hepatic arterial embolization (HAE) between 2006 and until 2013. Overall survival (OS) was calculated from date of HAE to date of death and estimated by Kaplan Meier Methods. Patients alive at their last follow up date were censored. Results: Of 243 patients who had undergone HAE at MSKCC during the study period, 36 patients had mHCC on initial diagnosis. Of these, 22 received HAE only, while 14 received HAE plus systemic therapy at some time during their whole treatment course. Conclusions: Patients with mHCC who underwent HAE alone had a poor OS. These data suggest that there maybe a survival benefit in patients with mHCC treated with transarterial therapies add to systemic therapy that is given at some time during their whole treatment course. These results contrast with recent data on the use of combined modality in locally advanced disease. Further studies of combined modality therapy in the setting of mHCC may be warranted. [Table: see text]

scholarly journals Targeted Therapies in the Treatment of Advanced Hepatocellular Carcinoma

2013 ◽  
Vol 7 ◽  
pp. CMO.S7633 ◽  
Author(s):  
Zhengyu Wei ◽  
Cataldo Doria ◽  
Yuan Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Targeted Therapies ◽  
Recent Progress ◽  
Systemic Treatment ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc ◽  
The Third ◽  
Promising Target ◽  
Targeted Treatments ◽  
Attractive Option

Hepatocellular carcinoma (HCC) is the most common liver cancer and the third leading cause of cancer death. It has been a major worldwide health problem with more new cases being diagnosed each year. The current available therapies for patients with advanced HCC are extremely limited. Therefore, it is of great clinical interests to develop more effective therapies for systemic treatment of advanced HCC. Several promising target-based drugs have been tested in a number of clinical trials. One breakthrough of these efforts is the approved clinical use of sorafenib in patients with advanced HCC. Targeted therapies are becoming an attractive option for the treatment of advanced HCC. In this review, we summarize the most recent progress in clinical targeted treatments of advanced HCC.

Real-world experience of pembrolizumab plus lenvatinib in unresectable hepatocellular carcinoma in Taiwan.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16627-e16627 ◽  
Author(s):  
Chi-Jung Wu ◽  
Ya-Wen Hung ◽  
Pei_Chang Lee ◽  
ChiehJu Lee ◽  
Ming Huang Chen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Real World ◽  
Systemic Treatment ◽  
Checkpoint Inhibitors ◽  
Medical Center ◽  
Objective Response ◽  
Post Treatment ◽  
Advanced Hcc ◽  
Unresectable Hepatocellular Carcinoma

e16627 Background: Multi-kinase inhibitors and immune checkpoint inhibitors (ICIs) are treatment options of systemic therapy for unresectable hepatocellular carcinoma (HCC). Targeted therapy can potentially enhance T cell infiltration and activation, consequently, cooperate with ICIs to produce synergistic anti-tumor effects. The ongoing clinical trial shows promising data by combining pembrolizumab with lenvatinib for advanced HCC. The study tried to evaluate the treatment response and adverse events of pembrolizumab plus lenvatinib for HCC in real-world setting. Methods: From Jul. 2019, patients who received pembrolizumab plus lenvatinib for unresectable HCC in a tertiary medical center in Taiwan were prospectively enrolled. The status of HCC was either in advanced HCC or failed by prior locoregional treatment. The dosage of pembrolizumab was 100mg every 3 weeks. The starting dose of lenvatinib was 10mg per day then titrating to weight-based dose according to recommendation. Patients who had received at least 2 cycles of pembrolizumab were evaluated in this report. The tumor response was assessed with Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and modified RECIST (mRECIST). The treatment related adverse events (TRAEs) were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results: Till the end of Jan. 2020, 27 patients had received at least 2 cycles of pembrolizumab, and 17 had evaluable post-treatment images either by CT or MRI. There were 6 (22.2%) in BCLC B, and 21 (77.8%) in BCLC C. Of them, 17 (63%) were treated as the first-line systemic treatment, 8 as the second-line and 2 as the third line systemic treatment. Of the 17 cases with post-treatment image studies, there were 6 (35.3%) in partial response (PR), 7 (41.2%) in stable disease (SD), and 4 (23.5%) in progressive disease (PD) by RECIST v1.1; and 1 (5.8%) in complete response (CR), 9 (52.9%) in PR, 3 (17.6%) in SD and 4 (23.5%) in PD by mRECIST, respectively. The objective response rate (ORR) and disease control rate (DCR) by mRECIST were 58.7% and 76.5%, respectively. The most common TRAEs in any grade were hypertension 24 (88.4%), palmar-plantar syndrome 19 (70.4%), hypothyroidism 19(70.4%). The Grade 3/4 TRAEs were 3 (11.1%) with psoriasis-like skin reaction, 3 (11.1%) with hypertension and 2 (7.4%) with palmar-plantar syndrome. Conclusions: Pembrolizumab plus lenvatinib can produce excellent ORR and DCR with tolerable safety profiles. Such combination could be a promising strategy for unresectable HCC in the future.

Treatment patterns and survival in patients with late-stage hepatocellular carcinoma in France: A retrospective database analysis.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 288-288
Author(s):  
Jean-frederic Blanc ◽  
Caroline Laurendeau ◽  
Nadia Kelkouli ◽  
Philippe Mathurin
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systemic Therapy ◽  
Late Stage ◽  
Systemic Treatment ◽  
Best Supportive Care ◽  
Treatment Patterns ◽  
Stage Disease ◽  
Systemic Treatments ◽  
Icd 10

288 Background: The prognosis for patients with late-stage hepatocellular carcinoma (HCC) is poor, with only one systemic treatment option available for patients until 2017. Aim: To describe treatment patterns and survival of French patients following diagnosis of late-stage HCC (Barcelona Clinic Liver Cancer classification B, C or D), using a comprehensive nationwide claims database, SNDS. Methods: The SNDS database was searched from 1 January 2015 to 31 December 2017 for patients with a diagnosis of HCC (ICD-10: C220) and late-stage disease, defined by the identification of transcatheter arterial chemoembolization (TACE) or radioembolization (TARE), HCC systemic therapy and/or best supportive care (BSC). Patients were followed up for a maximum of 2 years. Results: 17,298 patients (mean age: 68.7 years (SD: 11.3), 82.6% male) were identified, with 72.4% diagnosed at late stage. During follow-up, 29.6% of patients were treated with TACE or TARE, and 27.1% received systematic therapy (sorafenib in 99.5% of cases). The median duration of systemic treatment was 7.9 (95% CI: 7.4-8.5) months. In 62.5% of cases, this treatment was discontinued at 12 months; this proportion fell to 40.3% when using mortality as a competitive risk. Survival since diagnosis of late stage HCC differed according to the type of first treatment received. Median overall survival was 23.7, 11.9, 7.4 and 1 month in patients initially receiving TACE, TARE, systemic therapy or no treatment, respectively. Conclusions: These results confirm the high clinical burden of late-stage HCC over this period and the need for second-line systemic treatments to improve patient outcomes.

Prognostic factors of survival in 236 advanced hepatocellular carcinoma patients enrolled in prospective clinical trials of systemic therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15632-e15632 ◽  
Author(s):  
Z. Lin ◽  
D. Chang ◽  
Y. Shao ◽  
C. Hsu ◽  
C. Hsu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Clinical Trials ◽  
Prognostic Factors ◽  
Systemic Therapy ◽  
Objective Response ◽  
Advanced Hepatocellular Carcinoma ◽  
Phase Ii Trials ◽  
Advanced Hcc ◽  
Staging Systems

e15632 Background: Hepatocellular carcinoma (HCC) is a common malignant disease. Promising results of prospective clinical trials using systemic therapy for patients with advanced HCC are emerging. The aim of this study was to explore prognostic factors of survival in advanced HCC patients eligible for clinical trials of systemic therapy. Methods: From December 1990 to July 2005, 236 patients with unresectable HCC were enrolled into 6 phase II trials of systemic therapy using the following regimens: (1) oral etoposide + tamoxifen, (2)doxorubicin + tamoxifen, (3)IFN-α2b + doxorubicin + tamoxifen, (4)pegylated liposomal doxorubicin, (5)thalidomide, and (6)arsenic trioxide. Univariate and multivariate analyses of 23 relevant clinical characteristics/staging systems were used to identify prognostic factors of survival. Results: Baseline characteristics: median age 55; male/female: 192/44; HBsAg(+) 71%; anti-HCV(+) 30%; Okuda stage I/II/III: 42%/55%/3%; AJCC stage III/IV: 30%/61%; BCLC stage B/C/D: 1%/94%/5%; CLIP score 0–3/4–6: 70%/30%; portal vein thrombosis 53%; extrahepatic metastasis 59%; prior chemoembolization 46%. The objective response rate according to WHO criteria was 11.4%. The median overall survival was 118 days (95% CI, 103–133). In the multivariate analysis, significant predictors of a shorter overall survival were: HBsAg(+) with a hazard ratio (HR) = 1.808 (95% CI, 1.121–2.916; P= 0.015), symptomatic with HR = 1.745 (95% CI, 1.072–2.840; P= 0.025), ECOG≥2 with HR = 1.763 (95% CI, 1.040–2.988; P= 0.035), and high BCLC stage with HR = 3.282 (95% CI, 1.129–9.541; P= 0.029). Conclusions: Patients with advanced HCC who are eligible for systemic therapeutic trials have patient- and disease-related prognostic factors. Positive HBsAg, symptomatic, ECOG performance≥2, and high BCLC stage predict a shorter overall survival. No significant financial relationships to disclose.

scholarly journals Long-lasting remission in a metastatic hepatocellular carcinoma patient after combined regorafenib therapy and surgery

2020 ◽  
Vol 7 (3) ◽  
pp. HEP24
Author(s):  
Elisabetta Goio ◽  
Luca Ielasi ◽  
Francesca Benevento ◽  
Matteo Renzulli ◽  
Francesco Tovoli
Keyword(s):  
Hepatocellular Carcinoma ◽  
Clinical Data ◽  
Systemic Therapy ◽  
New Agents ◽  
Advanced Hcc ◽  
New Therapies ◽  
Systemic Treatments ◽  
Tumor Downstaging ◽  
Metastatic Hepatocellular Carcinoma ◽  
Personalized Approach

Aims: The therapeutic scenario of systemic treatments for hepatocellular carcinoma (HCC) is rapidly changing. There is much interest in the possibility of combining new therapies with surgery, but clinical data is lacking. We aimed to provide an example of such integration. Patients & methods: We report a patient with metastatic HCC who received regorafenib in the setting of the RESORCE trial. Results: A brilliant response led to a tumor downstaging and a subsequent adrenal metastasectomy with radical intent. Conclusions: New agents will change the therapeutic perspectives in advanced HCC and lead to a higher rate of objective responses, with possibilities of associating systemic therapy and surgery. Thus, the management of HCC will require more and more of an integrated, multidisciplinary and personalized approach.

scholarly journals Interventional Treatment of Hepatic Metastases from Colorectal Cancer

2020 ◽  
Vol 37 (05) ◽  
pp. 492-498
Author(s):  
Patrick D. Sutphin ◽  
Suvranu Ganguli
Keyword(s):  
Colorectal Cancer ◽  
Surgical Resection ◽  
Survival Benefit ◽  
Colorectal Liver Metastases ◽  
Systemic Treatment ◽  
Hepatic Metastases ◽  
Treatment Modalities ◽  
Interventional Treatment ◽  
Significant Survival ◽  
Systemic Therapies

AbstractModern systemic therapies provide a significant survival benefit in metastatic colorectal cancer. Despite these advances, the durability of response remains limited and nearly all patients progress on systemic treatment. Colorectal liver metastases (CLM) develop in approximately half of patients with metastatic disease and contribute to mortality in most patients. In selected patients, surgical resection of hepatic metastases prolongs survival, indicating the benefits of the targeted treatment of CLM through alternate means. Minimally invasive interventional treatments offer the promise of treating CLM in a wider range of patients than those eligible for surgical resection. Thermal ablation and intra-arterial therapies, including chemoembolization and radioembolization, are commonly used in the treatment of CLM. Each of these treatment modalities will be discussed in detail with an emphasis on the available clinical data for each interventional treatment for CLM.

scholarly journals Comparison of Surgical Resection and Systemic Treatment for Hepatocellular Carcinoma with Vascular Invasion: National Cancer Database Analysis

Liver Cancer ◽  
2021 ◽  
pp. 1-12
Author(s):  
Rajalakshmi Govalan ◽  
Marie Lauzon ◽  
Michael Luu ◽  
Joseph C. Ahn ◽  
Kambiz Kosari ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Surgical Resection ◽  
Systemic Therapy ◽  
Vascular Invasion ◽  
Systemic Treatment ◽  
Multivariable Analysis ◽  
National Cancer Database ◽  
Factors Associated ◽  
The Usa

<b><i>Introduction:</i></b> Small studies from outside of the USA suggest excellent outcomes after surgical resection for hepatocellular carcinoma (HCC) with vascular invasion. The study aims to (1) compare overall survival after surgical resection and systemic therapy among patients with HCC and vascular invasion and (2) determine factors associated with receipt of surgical resection in a US population. <b><i>Methods:</i></b> HCC patients with AJCC clinical TNM stage 7th T3BN0M0 diagnosed between 2010 and 2017 from the National Cancer Database were analyzed. Cox and logistic regression analyses identified factors associated with overall survival and receipt of surgical resection. <b><i>Results:</i></b> Of 11,259 patients with T3BN0M0 HCC, 325 (2.9%) and 4,268 (37.9%) received surgical resection and systemic therapy, respectively. In multivariable analysis, surgical resection was associated with improved survival compared to systemic therapy (adjusted hazard ratio: 0.496, 95% confidence interval: 0.426–0.578) with a median survival of 21.4 and 8.1 months, respectively. Superiority of surgical resection was observed in noncirrhotic and cirrhotic subgroups and propensity score matching and inverse probability of treatment weighting adjusted analysis. Asians were more likely to receive surgical resection, whereas Charlson comorbidity ≥3, elevated alpha-fetoprotein, smaller tumor size, care in a community cancer program, and the South or West region were associated with a lower likelihood of surgical resection. <b><i>Conclusion:</i></b> HCC patients with vascular invasion may benefit from surgical resection compared to systemic therapies. Demographic and clinical features of HCC patients and region and type of treating facility were associated with surgical resection versus systemic treatment.

Eligibility of patients with hepatocellular carcinoma for systemic treatment with sorafenib

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15673-e15673
Author(s):  
L. C. Zimmermann ◽  
K. Schuette ◽  
J. Borschein ◽  
A. Csepregi ◽  
P. Malfertheiner
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Systemic Treatment ◽  
Advanced Disease ◽  
Tumor Stage ◽  
Best Supportive Care ◽  
Advanced Hepatocellular Carcinoma ◽  
Transarterial Chemoembolisation ◽  
Local Ablative Therapy ◽  
Systemic Drug

e15673 Background: Sorafenib is the first systemic drug that effects prolonged overall survival in patients with advanced hepatocellular carcinoma (HCC) by almost three months with moderate toxicity. This study aims to evaluate how many patients diagnosed with HCC are candidates for systemic treatment and possibly benefit from it. Methods: All patients diagnosed with HCC in our hospital in between January 2006 and June 2008 were analysed regarding the presence and stage of liver cirrhosis, tumor stage and the treatment applied. Results: In a period of 30 months 182 patients were diagnosed with HCC (female n = 42, male n = 140, median age 66 (16–84)). 169 suffered from liver cirrhosis, 96 in Child A, 46 in Child B and 27 in Child C stage. 36 patients (19.8 %) were diagnosed with uninodular disease, in 17 patients (9.3%) 2 or 3 nodules were detected and 129 (70.9%) patients suffered from multinodular HCC. 79 patients received local ablative therapy or transarterial chemoembolisation, 15 underwent surgical resection, 29 patients were treated with best supportive care and 59 patients were candidates for systemic treatment. Out of these 25 either had no liver cirrhosis or were in stage Child A and 17 were in Child B stage and would therefore fit for therapy with sorafenib (23.1%). 17 pts with advanced disease and Child C cirrhosis did not fit for this treatment. Conclusions: Assuming that patients with advanced HCC and good or moderate liver function are candidates for systemic treatment with sorafenib every fifth patient is likely to benefit from the introduction of this treatment option. [Table: see text]

A phase I/II trial to evaluate cabozantinib in patients with advanced hepatocellular carcinoma with Child-Pugh class B cirrhosis after first-line therapy.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. TPS357-TPS357
Author(s):  
Thomas Enzler ◽  
Neehar Parikh ◽  
Chih-Yi Liao ◽  
Aparna Kalyan ◽  
David Hsieh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Phase I ◽  
Systemic Treatment ◽  
Advanced Hepatocellular Carcinoma ◽  
First Line ◽  
Early Stage Disease ◽  
Advanced Hcc ◽  
Line Therapy ◽  
Class B ◽  
Pugh Class

TPS357 Background: Hepatocellular carcinoma (HCC) is the 4th leading cause of cancer related death worldwide. HCC typically develops in patients with cirrhosis and has a 5-year survival estimate of 20%. Only patients with early stage disease may be eligible for a curative approach using local treatment and/or transplant. The majority of patient present with advanced HCC and will require systemic treatment for disease control. Several systemic therapies are FDA-approved for the treatment of HCC; however, they are only approved for patients with Child-Pugh class A cirrhosis. There are limited data and no approved second-line therapy for HCC with more advanced cirrhosis, including Child-Pugh class B, which represents a significant proportion of patients. The aim of this trial is to determine the safety and efficacy of cabozantinib, a multi-kinase inhibitor, in patients with HCC with Child-Pugh class B cirrhosis. Methods: This investigator-initiated, phase I/II study is enrolling 32 patients with advanced HCC, Child-Pugh B7 or B8, who have previously received first-line systemic treatment. Patients receive cabozantinib at one of 3 dose levels (20 mg, 40 mg, and 60 mg) with a starting dose level of 40 mg to evaluate the safety profile and obtain the recommended phase 2 dose (RP2D). The primary endpoint is assessment of dose-limiting toxicity with a null hypothesis greater than 35%. Secondary endpoints include ORR per RECIST v1.1, PFS, OS, and PK profile. Exploratory endpoints include whole exome/RNAseq analysis (including MET, VEGF, AXL, and immune signature), spatial profiling of immune markers by multiplex immunofluorescence, and specimen banking (tissue, blood and imaging). The trial design is based on the Time-To-Event modification of the Continual Reassessment Method (TiTE-CRM), which allows for continued monitoring of toxicity as a function of a dose-over-time, and is flexible with regard to the number of patients treated at a certain dose. The trial is open at University of Michigan as lead and coordinating site, and due to open at 3 additional high-volume centers. Clinical trial information: 04497038.

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