Management of Hepatocellular Carcinoma: Future Directions in Care

Expert insight to how the field of hepatocellular carcinoma management may evolve in coming years given therapeutic combinations and ongoing clinical trials.


Josep Llovet, MD: I have 1 final question for all of you, [what] are your take-home messages? I think you have 15 seconds each. Who wants to start, Andrea?

Andrea Casadei-Gardini, MD: The take-home message is that we have several options for our patients, and it’s important to select the best choice for our patients. The future is at this point for me.

Katie Kelley, MD: I agree. As we now have these multiple choices in first-line and later-line therapies,we need to continue gathering data, both in registries and as well as prospectively, on how to find the best clinical biomarkers, as well as ongoing collection of blood and tumor specimens to really stratify which patients are more likely to respond or benefit.

Amit Singal, MD: I completely agree with both of those comments. The other thing that I’d say is it’s important to remember that we are dealing with a larger landscape. We spent the vast majority of the time—because of all the advances—in the advanced stage setting, but I think we have to remember there are other therapies that are also highly efficacious, including the surgical therapies and locoregional therapies. I think some of the real-world data we’ve seen have shown expansion, right or wrong, of some of those systemic therapies in even early stage patients. Despite the excitement, I think we have to make sure that patients who are found at an early stage get discussed in a multidisciplinary setting so we can apply surgical therapies or locoregional therapies when possible. Or, we’ll see where the field goes, potentially combinations. But I think it’s the type of thing where [in] systemic therapies we’ve seen notable advances, but we have to make sure that we consider the broader treatment landscape. And that’s best done with data showing this in a multidisciplinary fashion.

Arndt Vogel, MD: It’s always difficult when you are almost last, and everything has been said.

Joseph Llovet, MD: I’m the last.

Arndt Vogel, MD: You’re the last one, I’m looking forward to your comment. I agree. The tumor board is important to identify patients for the right treatment, which includes local therapies; expanding options are really exciting. Now, as you have said, we have more points to discuss, more points to agree and disagree on. And we need these discussions to come up with conclusions because we will be in situations where we do not have the evidence we would like to have, and then we need to decide what is the best approach. To have controversial discussions on that, I think will be most helpful to find the best thing.

Josep Llovet, MD: My take-home message is that we’re very lucky that now we have all these options. Twenty years ago there was [only] best supportive care for these patients, for advanced stage HCC [hepatocellular carcinoma]. We’re very lucky there have been, at least in advanced stage, revolutions, first systemic therapy, TKI [tyrosine kinase inhibitor], and now first combinations, and then the combos that are coming. I envision another revolution in the next 2, 3, 4 years that will be systemic therapies in combination or head-to-head. I think [it] would be in combination with TACE [transarterial chemoembolization] and in the adjuvant setting; that clearly is an unmet need. If this happens, we’ll have another revolution in HCC.

With that said, I would like to thank our panelists, Drs Kelley, Vogel, Casadei, and Singal for this rich and informative discussion. And to our viewing audience, thank you for joining us. We hope that you found this OncLive® Peer Exchange discussion to be useful and valuable to the treatment of your patients with hepatocellular carcinoma. Thank you very much for your attention.

Transcript edited for clarity.

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