Info

🌱 來自: hepatocellular carcinoma

Treatment of hepatocellular carcinoma

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(NEJM 2019;380:1450) Hepatocellular Carcinoma | NEJM

• Localized disease (goal = cure) → resection if feasible (preferred), ablation, transarterial chemoembolization, or radiotherapy (SBRT) also options. Inadequate hepatic reserve → liver transplant if able (NEJM 1996;334:693); non-surgical local and/or systemic Rx if not.
• Systemic Rx:
  • Atezolizumab + bevacizumab preferred (NEJM 2020;382:1894),
  • PD-(L)1 inhib (Lancet 2017;389:2492 & 2018;391:1163)
  • 2nd line: kinase (sorafenib) or
  • Sorafenib 抗癌藥與臨床應用

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OS

• First: Atezolizumab + bevacizumab 19.2 months
• First/second Sorafenib: 14.6-10.7 months/
• lenvatinib: 13.7
• 3er: Regorafenib: 10.6 months
• Cabozantinib: 10.2 months
• Ramucirumab (AFP >400): 8.1 months (HCC; qv in Heme-Onc) (Nature Reviews 2021;7:6)
• ↑ risk w/ cirrhosis of any type (leading cause of death in cirrhosis, 1–6%/y) but esp. ↑ w/ viral (Hep B/C~3–8%/y), concomitant EtOH use, obesity related NASH, HFE or diabetes
• Clinical: asx vs. hepatic decompensation (eg, ascites, HE), PVT w/ tumor thrombus
• Dx: screen Pts w/ cirrhosis q6mo w/ U/S ± AFP; alternative is dual-phase CT/MRI
• Rx: see “HCC” in Heme-Onc