Evolving Treatment Paradigms for Metastatic Liver Cancer - Episode 15

The Future of HCC Management


Ghassan K. Abou-Alfa, MD, MBA: Ahmed, in your view, Monday we’re going to see patients. Tuesday, we’re in the research lab or in the research office discussing the future. Where are you going to take the field of HCC [hepatocellular carcinoma] next?

Ahmed Kaseb, MD: I think personalizing therapy approaches starts from knowing how healthy your patient is and how healthy the liver is—it’s a multidisciplinary approach with our hepatology colleagues to identify that and categorize the patients better than just Child-Pugh score.

No. 2, the future is moving toward the personalization and combination of therapy. Hopefully we also get to a point where we’re actually powering our studies and asking to look at the risk factors. Specific as we have mentioned, there is some clinical value to this. And then at the end of the day, it comes down to what your patient wants you to do. I always come down to this question: What’s your view of life and how can we help you, because you’d be surprised in some patients who value quality of life much more than a number of overall survival or some response rate.

Ghassan K. Abou-Alfa, MD, MBA: Good thoughts on personalization of medicine. Of course, understandably, look at the patient’s perspective and also, which I stressed quite a bit and we spoke about the multidisciplinary team or the tumor board approach. Pierre, what are you going to do on Tuesday?

Pierre Gholam, MD: This is obviously a very exciting time. On Tuesday, I think I will consider systemic therapy as a viable option for many of my patients who have BCLC [Barcelona Clinic Liver Cancer] stage B—in other words, locally advanced disease. Because we will be getting a response rate and an overall survival rivaling what one might achieve with locoregional therapy in many of those patients. I think this will be a paradox shift in the next few years.

Ghassan K. Abou-Alfa, MD, MBA: Fair enough. So local therapy. Catherine, again, patient first: Monday patient care. Tuesday, research.

Catherine T. Frenette, MD: I think we really need more data on sequencing. That is really a desperate place right now. I also think that 1 of the main things we really need to develop is the use of biomarkers to really tell us, of the multitude of choices we have, what’s going to work for the patient in front of us. That would be incredibly helpful.

Ghassan K. Abou-Alfa, MD, MBA: That’s very important as well. The sequencing component and the choices, as we just heard and we discussed a little, when we’ll talk about the etiology related to the choices of therapy. Anthony, your thoughts.

Anthony B. El-Khoueiry, MD: It’s always hard to be last.

Ghassan K. Abou-Alfa, MD, MBA: You’re not there yet.

Anthony B. El-Khoueiry, MD: I second what Cathy said. I think we really have to do a better job. This is a heterogeneous broad disease. We need to break it down into subgroups, molecular subgroups hopefully that can guide therapy better and work on better biomarkers. We also need to start paying more attention to quality of life. More patient-reported outcomes are being incorporated into studies to ensure that we prolong survival but improve quality as well. That’s critical. Lastly I would say, because we have a multitude of therapies, and the data are moving so fast, it’s very important for us to stay data driven and do therapy based on evidence.

Ghassan K. Abou-Alfa, MD, MBA: It is, again, very important that we look at the etiologies, we look at the outcome of the patient. If I were to add anything, I think the components of evaluation are very critical. We’re very proud, all of us, and all our patients are very happy and proud of the efforts we’ve been doing for the last 2 decades in regard to the TKIs [tyrosine kinase inhibitors], the antiangiogenics, the checkpoint inhibitors, and of course potential further roles.

I would say that the next step—we’ve been there, we’ve done that—there will be some variation and adjustment, as we just heard from all our colleagues. Remember, the aim that we need to move folks on is cure of the patient. The thing with advanced disease at least 1 notion of cure is coming from CAR T [chimeric antigen receptor T cells], and I would say the focus on CAR T in some tumors to begin with, and specifically in HCC [hepatocellular carcinoma], is definitely something that’s very critical to take time and evolve as we proceed further with our research.

With this, I thank you. On behalf of the panel, we hope you found this Peer Exchange® discussion to be useful and informative.

Transcript Edited for Clarity