Diagnosis of HCC: Presentation of Disease



Ghassan K. Abou-Alfa, MD: Hello, and welcome to this OncLive® Peer Exchange® panel discussion titled “Global Perspective on Treatment of Hepatocellular Carcinoma.” The treatment of advanced hepatocellular carcinoma is complicated by the fact that cirrhosis is present in the majority of patients. However, after a decade of negative data following the approval of sorafenib for metastatic liver cancer, we are now entering an exciting era of new treatment options and new opportunities for sequencing systemic therapies. In this OncLive® Global Peer Exchange® program, I am joined by a group of international experts in the management of advanced hepatocellular carcinoma. Together, we will take an in depth look at the latest research, including the abstracts presented at the ASCO 2018 annual meeting. We’ll discuss the practical relevance of the data and their application to clinical care.

I am Dr. Ghassan Abou-Alfa, and I’m a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City, New York. Participating today on our distinguished panel are Dr. Arndt Vogel, professor of gastrointestinal oncology and managing senior consultant of the Department of Gastroenterology, Hepatology and Endocrinology at the Hannover Medical School in Hannover, Germany. Professor Masatoshi Kudo, professor of the Department of Gastroenterology and Hepatology Faculty of Medicine at Kindai University in Osakasayama, Japan. And Dr. Richard Finn, associate professor of medicine in the Department of Medicine, Division of Hematology/Oncology of the Geffen School of Medicine at UCLA in Los Angeles, California. Thank you so much for joining us. Let’s begin.

So, no doubt that, as I said in the introduction, hepatocellular carcinoma out of nothing is really great news for all of us. However, to be fair, let’s start somewhere, like who gets HCC. Rich, please tell us, in your practice, who are your patients? What is the risk factor? Why do they come with HCC?

Richard S. Finn, MD: So, as you noted in the introduction, the majority of these patients have underlying liver disease and that has made it a global disease. In the United States historically, and being in Los Angeles, that has been driven by the hepatitis C epidemic. Still, you’re in New York, I’m in LA, we probably see a little more hepatitis B-related liver disease because of the large Asian population. And in the news, we know that hepatitis C is going to be gone in a little period of time, right? The new drugs for hepatitis C are very effective, yet we still expect a rise in liver cancer because there’s now this epidemic of obesity, fatty syndrome, and insulin resistance that is driving the development of nonalcoholic steatohepatitis (NASH). And, obviously, there’s other metabolic things—hemochromatosis, alcohol-related liver disease. The common denominator being some insult to the liver in 90% of the patients. I think still the majority, at least in the United States, is probably hepatitis C.

Ghassan K. Abou-Alfa, MD: I hear loud and clear, and I totally agree with you—hepatitis C, hepatitis B, alcohol, nonalcoholic steatohepatitis. But let’s see what’s going on in other parts of the world. So, for you, Masatoshi, what do you see in Japan?

Masatoshi Kudo, MD, PhD: In Japan, of course, hepatitis C is most frequent. Hepatitis C is around 60%, and hepatitis B-related liver disease is around 15%. Recently, the obese, diabetic, metabolic syndrome, or NASH have begun to gradually increase.

Ghassan K. Abou-Alfa, MD: Interesting.

Masatoshi Kudo, MD, PhD: Yes.

Ghassan K. Abou-Alfa, MD: I’ll tell you one word at the end of the day, and it’s fascinating to see this. And for you, Arndt, are you seeing the same thing in Germany? What’s there?

Arndt Vogel, MD: Yes, I think it’s very much the same. In the past, we had a lot of patients with viral hepatitis. Hepatitis B and C were almost equally distributed and a lot of alcoholic cirrhosis as well. And now we see this increase in NASH, which is clearly a different population to what we have seen before. So, I think NASH will be probably the most significant driver for HCC in the future.

Ghassan K. Abou-Alfa, MD: I have to admit, this really comes to me as a surprise, but this is really the value of this international panel that we have. As Rich Finn just mentioned, in our practices in the United States, we see the hepatitis B, we see the hepatitis C, and we see the alcohol. And definitely there’s a concern about the NASH because of how our population is really having a problem in regard to the morbid obesity and the diabetes. But it’s fascinating. This is new to me, even as I hear that the same concern is brought up from Japan or from Germany, which really tells us that this is really a global problem afterwards, which means that, in other words, we’re going to see more and more HCC.

Transcript Edited for Clarity Brought to you in part by Eisai

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