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Treating Unresectable HCC in the Community

Insights From: Richard S. Finn, MD, University of California Los Angeles
Published: Friday, Jan 31, 2020



Transcript: 

Richard S. Finn, MD: Unresectable liver cancer is a pretty diverse group of patients, right? For patients in the community, I always stress that they should get at least an opinion from a tertiary center, and certainly 1 that has a transplant program. Some of these intermediate, unresectable patients might be candidates for transplant after a downstaging procedure. If they’re not, they will certainly come back. But the rules for transplant are constantly changing, and I think given that it’s a curative approach, patients should be considered at 1 of these centers first.

If a patient clearly is not a transplant candidate—they have vascular invasion or extrahepatic spread—these are patients who should get systemic treatment. The data to use locoregional treatment such as chemoembolization or Y90 radioembolization are not there right now for these patients who have more advanced disease, in that unresectable group. We need to keep in mind that there are many systemic treatments available.

Keep in mind that patients who have intermediate disease who get chemoembolization will eventually progress and become advanced. And so it’s important that community oncologists keep involved with their patients. If they send them for a procedure, they should see them back and regularly monitor them. When they have radiographic progression, that’s probably when we would sequence them to systemic treatment. If you wait until they have decompensation, we can’t do another chemoembolization because their bilirubin is high or they have ascites. Then we’re not going to be able to impact them and improve their survival the way we want to. Clinical trial populations are not necessarily what we see every day in practice. However, it’s very important for us to try to capture patients like that because that’s the group of patients who will benefit most from our new treatments.

Transcript Edited for Clarity
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Transcript: 

Richard S. Finn, MD: Unresectable liver cancer is a pretty diverse group of patients, right? For patients in the community, I always stress that they should get at least an opinion from a tertiary center, and certainly 1 that has a transplant program. Some of these intermediate, unresectable patients might be candidates for transplant after a downstaging procedure. If they’re not, they will certainly come back. But the rules for transplant are constantly changing, and I think given that it’s a curative approach, patients should be considered at 1 of these centers first.

If a patient clearly is not a transplant candidate—they have vascular invasion or extrahepatic spread—these are patients who should get systemic treatment. The data to use locoregional treatment such as chemoembolization or Y90 radioembolization are not there right now for these patients who have more advanced disease, in that unresectable group. We need to keep in mind that there are many systemic treatments available.

Keep in mind that patients who have intermediate disease who get chemoembolization will eventually progress and become advanced. And so it’s important that community oncologists keep involved with their patients. If they send them for a procedure, they should see them back and regularly monitor them. When they have radiographic progression, that’s probably when we would sequence them to systemic treatment. If you wait until they have decompensation, we can’t do another chemoembolization because their bilirubin is high or they have ascites. Then we’re not going to be able to impact them and improve their survival the way we want to. Clinical trial populations are not necessarily what we see every day in practice. However, it’s very important for us to try to capture patients like that because that’s the group of patients who will benefit most from our new treatments.

Transcript Edited for Clarity
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