Hepatocellular Carcinoma: Practical Implications of Emerging Data - Episode 19
Richard S. Finn, MD: This has been an amazing discussion with an amazing group of colleagues. Thank you all for participating. Maybe we can leave the audience with a final thought. I’ll start with you, Dr Bekaii-Saab.
Tanios S. Bekaii-Saab, MD, FACP: Thank you. This was a wonderful discussion. What we’re seeing is an incredibly transformative effort in liver cancer. The days of about 10 years ago, where we had no options whatsoever and a meager survival, are being transformed into a lot of options, from immuno-oncology to TKIs to combinations. With survival, patients are getting closer to 2 years from a meager 7 months and continue moving upward. So these are exciting times.
Richard S. Finn, MD: Dr El-Khoueiry?
Anthony El-Khoueiry, MD: To second what you said, Richard, I will pitch for continued enrollment in clinical trials but also for multidisciplinary care. We still see many patients not being directed to the right therapy or not having multidisciplinary evaluation, and this is critical for outcomes in hepatocellular carcinoma. I also look to our hepatology colleagues. We’ve said it multiple times: We are treating 2 diseases at once. Therapies that may address the underlying fibrosis, the underlying portal hypertension, are still critical to improve cancer outcomes as well. That’s my parting philosophical commentary.
Richard S. Finn, MD: Always welcome. Dr Kelley?
R. Kate Kelley, MD: I’ll summarize also, but what both Tony and Anthony said is that we see our systemic therapy options moving both earlier and later in the spectrum of disease, as we are seeing unprecedented efficacy. More options for patients failing TACE [transarterial chemoembolization] or before they have a chance to or need to, and also multiple lines of therapy are now a possibility.
Richard S. Finn, MD: Dr Salgia?
Reena Salgia, MD: I would also echo what’s been said. These are exciting times for what’s a devastating condition to have. As a provider, I would make a push for us to think more in terms of considering biopsies in more carefully selected cases, so we can glean additional data, especially in the future, if we do have more targets for therapy. Additionally, we should work closely in our multidisciplinary teams and with our colleagues in surgery and interventional radiology to educate them on the data in this regard and really try to emphasize that we should be considering strongly initiation of systemic therapy while patients remain in Child-Pugh A status.
Richard S. Finn, MD: Amit, it’s always hard to be original at the end. But I know you can do it.
Amit Singal, MD: I’m going to start by reiterating the point about multidisciplinary care, particularly when we think about stage migrations. With all the combination therapies that are coming around, it even makes it much more important. The fact that this has been associated with improved survival really highlights that it’s important. Rich, to your point of trying to be original, I’m going to end where we started with the whole surveillance discussion and the fact that early detection is really critical. We’ve seen a lot of advances in the advanced-stage setting, which are really exciting. We really have to work as a community to promote surveillance, to really find all these cancers as early as possible so we can deliver curative surgical therapies if and when possible.
Richard S. Finn, MD: Yes, and it’s so exciting to be able to talk to patients now and say, “We are not only improving survival but have a high chance of getting responses.” We’re getting a handle on managing toxicities and a different type of toxicity. It’s just a very exciting time to be an investigator in the liver cancer space, and for physicians in the community to have an arsenal of options to help patients live longer. With those closing thoughts, I’d like to thank you again, our viewing audience. We hope you found this OncLive® Peer Exchange® discussion to be useful and informative. Stay well. Thank you very much.
Transcript Edited for Clarity