Hepatocellular Carcinoma: Practical Implications of Emerging Data - Episode 1

Incidence of Liver Cancer in the US

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Richard S. Finn, MD: Hello, and welcome to this OncLive Peer Exchange® titled, “Hepatocellular Carcinoma: Practical Implications of Emerging Data.” I’m Dr Richard Finn from the David Geffen School of Medicine at UCLA. I’m joined by an outstanding faculty today for a discussion, including Dr Bekaii-Saab, from the Mayo Clinic in Arizona; Dr Anthony El-Khoueiry, from USC Norris Comprehensive Cancer Center here in Los Angeles; Dr Katie Kelley from the University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Dr Reena Salgia, from the Henry Ford Health System; and Dr Amit Singal, from the UT Southwestern Medical Center.

Today, we are discussing a number of topics regarding the use of systemic treatment in advanced liver cancer. We’ll discuss the latest research in the field, including from the ASCO [American Society of Clinical Oncology] 2020 virtual meeting, and the impact of recent clinical trials on making decisions around treatment selection.

Let’s get started with our first topic, early stage liver cancer. Amit, could you walk us through some of the epidemiologic factors in regard to the development of early liver cancer and how we can impact our patients?

Amit Singal, MD: Yes, I’m happy to, Rich. First, it’s exciting to be part of this great panel. As we know, HCC [hepatocellular carcinoma] is the fourth leading cause of cancer-related death worldwide, and we know that it’s not evenly spread across the world. The highest incidence and mortality rates are in East Asia and Africa, and this is driven by high rates of hepatitis B in those areas. In the United States, this is a cancer that’s gaining more attention because of the rapidly rising incidence and mortality rates. When you look at the last 15 years assessed by SEER [the Surveillance, Epidemiology, and End Results program], HCC has had one of the largest rises in incidence among all common cancers. It’s projected if this continues that HCC could become the third leading cause of cancer-related death here in the United States. One of the unique things about HCC is that we have an identifiable target population. It primarily develops in those patients with chronic liver disease, and over 90% occur in the setting of cirrhosis. This can happen from any host of chronic liver diseases, including viral hepatitis, like hepatitis B or hepatitis C. There is a certain proportion due to alcohol-related liver disease. And we’re finding more and more is related to what is now called metabolic-associated fatty liver disease, which is liver disease that happens in the setting of obesity and diabetes. As those become more common in the United States and worldwide, we’re seeing more HCC related to this etiology.

Richard S. Finn, MD: We’ve heard a lot about the new advances in hepatitis C treatment, right? Is liver cancer going to go away now that we’ve cured hepatitis C?

Amit Singal, MD: I wish that was the case. You’re right that when we treat viral hepatitis, we see a nice drop in the HCC incidence. But the first thing is that once you have cirrhosis, that doesn’t go away completely, you don’t eliminate that risk. Those patients still have an annual incidence rate above 1%, and therefore continue to need surveillance and need to be observed for the development of HCC. Even if we get rid of viral hepatitis, as I said, we still have large proportions that are related to alcohol and metabolic-associated fatty liver disease, and increases in those areas are likely largely offsetting any decreases in HCC-related viral hepatitis. I don’t think this is a disease that is going to go away anytime soon.

Transcript Edited for Clarity