Treatment options evolve as HCC becomes more common

Treatment options evolve as HCC becomes more common
Posted By: DDW Daily News on: May 23, 2016
In: AASLD, By Society, DDW Daily News, Monday, May 23

A panel of experts will discuss the latest surveillance options, liver transplantation rules and immunotherapy guidelines for the treatment of hepatocellular carcinoma (HCC) during an AASLD Clinical Symposium Tuesday morning titled Hepatocellular Cancer.

Lewis R. Roberts, MB, ChB, PhD

Lewis R. Roberts, MB, ChB, PhD, professor of medicine and director of the hepatobiliary neoplasia clinic at Mayo Clinic, Rochester, MN, will co-moderate the session with Laura Kulik, MD, associate professor of hepatology at Northwestern University’s Feinberg School of Medicine, Chicago, IL.

“HCC is increasing in the U.S. and worldwide,” Dr. Roberts said. “It may not be inherently more pernicious than other cancers, but it is too often diagnosed at a late stage when effective treatment is difficult.”

As the prevalence of HCC increases, a growing body of evidence is helping to refine surveillance and increase earlier detection when treatment is more likely to be effective. At the same time, the profile of HCC is changing. Many clinicians matured in an era when viral hepatitis was the primary risk factor for HCC. Newer, more effective therapies can cure hepatitis C (HCV) in most patients, but simply curing a patient of HCV does not completely eliminate the need for HCC surveillance. And mounting evidence linking fatty liver disease to HCC adds to the importance of identifying patients at increased risk of progressing to cirrhosis and possibly HCC.

And even as the HCC burden shifts from patients with viral hepatitis to patients with advanced fatty liver disease, organ allocation rules for liver transplants are changing.

“The new rules are basically making HCC patients wait longer to get a liver,” Dr. Kulik said. “There is a kind of time-out period — six months — before the priority points that HCC patients get begin to work in their benefit. That six-month waiting period makes it particularly important for physicians to refer patients for transplant as early as possible.”

The new rules are intended to weed out patients with aggressive HCC who are less likely to benefit from a liver transplant. One consequence of the waiting period is a renewed push for liver-directed therapy.

“What we are seeing is a need to be more aggressive in treatment for these patients,” Dr. Roberts said. “For some patients, we treat in the hope of downstaging them so they become eligible for transplantation. For others with advanced cancer who have no likelihood of becoming eligible for transplantation, the focus is on developing more effective treatments.”

Novel checkpoint inhibitors that block tumor cells’ ability to evade the immune system have shown significant effects in treating lung cancers and melanomas. Some of those same agents show promise against liver cancer in early-stage clinical trials, Dr. Roberts noted.

“Researchers have identified some of the mechanisms by which cancer cells cloak themselves from attack by the immune system,” he explained. “New agents such as the PD1 inhibitor nivolumab unmask tumor cells so the immune system finds and destroys them. The early results were quite exciting because we could see significant response rates even in advanced HCC.”

The new checkpoint inhibitors can cause both gastrointestinal and hepatic side effects, therefore it is important for GIs to become familiar with the agents, Dr. Kulik noted.

“We know that clinicians are only going to be seeing more HCC in daily practice,” she said. “This symposium will provide the most up-to-date information so they can better handle these patients.”

Please refer to the DDW Mobile App or the schedule-at-a-glance in Tuesday’s issue for the time and location of this and other DDW® events.