Multidisciplinary Treatment Strategies for Hepatocellular Carcinoma - Episode 5

The Importance of HCC Multidisciplinary Management

Transcript:Ghassan K. Abou-Alfa, MD: Farshid, you mentioned that for patients with HCC [hepatocellular carcinoma], it would be wise to discuss their medical situation and the multidisciplinary teams. You also mentioned, however, that the IR [interventional radiology] doctors might contribute more than us oncologists. Tell me a little more about that.

Farshid Dayyani, MD: Historically, systemic treatment options were very limited. As you know, over the past 10 years, we had only 1 drug approved for this disease. So obviously, in the majority of cases, the liver is where the major disease burden of these patients typically was. Local control is always very important, and that kind of highlighted the role of intervention radiology. But I think with more affective systemic treatments, which we will talk about later, the rules might be changing—there is more cooperation than there used to be at the multidisciplinary site.

Ghassan K. Abou-Alfa, MD: Fair enough. So what we learned at this point in time is that, number 1, there are 3 treatments that lead to cure or transplant, and surgery and radiofrequency ablation. In addition to that we heard that the transplant criteria varies. Amit already mentioned to us that the reference is the Milan criteria, which was published first.

Multidisciplinary transplant teams always talk about what’s called the “metro ticket”. In general, in most cities world-wide, if you’re taking metro, the further you are away from the middle of town, the more costly it is. As such, the more expensive the Milan-equivalent criteria—whatever criteria you want for a transplant—the chance for recurrence is higher. In other words, the survival will also be lower. And that’s kind of where this conversation arises amongst experts regarding which criteria we should rely most upon.

Another important point that we just discussed is the multidisciplinary team. This team isn’t exclusive, but some of the typical players involved include surgeons, transplant surgeons, hepatologists, interventional radiologists, gastroenterologists, the medical oncologists, radiation oncologist, and palliative care units.

I have to say, as medical oncologists, we don’t usually go to those multidisciplinary teams as often as we should. Farshid, give me a fair reason why, because we didn’t have choices of therapy; nowadays, however, we do. If anything, it’s very important that we are there. I have to say that I had the experience of being at one of those meetings in an institute that I was visiting, and the oncologists could not come because they were in clinic. I just happened to be there but, of course, I’m visiting, so I was like a fly on the wall.

You won’t believe how many times we are amiable to systemic therapy. But we really have to sit down and talk and discuss with our colleagues.

Transcript Edited for Clarity