OVERVIEW

Medical Crossfire®: Linking Current Evidence to Treatment Planning for Hepatocellular Carcinoma (HCC): A Multidisciplinary Tumor Board is organized by Physicians' Education Resource, LLC (PER).

Release Date: October 31, 2019
Expiration Date: October 31, 2020

Accreditation:
Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Overview:
Following a decade-long paucity of new drug options for the management of hepatocellular carcinoma (HCC), the oncology community has seen an explosion of progress in novel strategies for patients with these tumors. Currently, surgical resection, local ablation, and liver transplantation represent curative options for patients with early-stage HCC. For transplant-ineligible patients with unresectable, more advanced disease, National Comprehensive Cancer Network Guidelines® recommend treatment management with transarterial chemoembolization, transarterial radioembolization, ablation, or radiation therapy or treatment with the small molecule tyrosine kinase inhibitors (TKIs) sorafenib and lenvatinib. Over the past 2 years, the FDA has approved next-generation TKIs (eg, regorafenib and cabozantinib) and immune checkpoint inhibitors (eg, nivolumab and pembrolizumab) for the second-line treatment of patients with advanced HCC. Furthermore, the monoclonal antibody ramucirumab is the first drug to be approved for advanced HCC based on the presence of high levels of the clinical biomarker α-fetoprotein, which is expressed in more than 40% of these patients. With the recent availability of these new agents, the sequencing of therapies for patients with advanced HCC has become far more promising but also far more complicated than in the past. Not only do clinicians need to understand the indications for these agents, but they must also be informed about common adverse events (AEs) associated with these drugs and management techniques to proactively mitigate predictable treatment-related AEs, to optimize outcomes and maintain patients on therapy whenever possible.

Because curative and palliative treatments are often used in combination for patients with all stages of HCC, effective management of this disease requires a multidisciplinary collaboration between hepatologists, pathologists, oncologists, interventional radiologists, and surgical oncologists. This educational activity was designed to provide expert guidance on the multidisciplinary approach to core concepts in HCC.

Learning Objectives:
Upon successful completion of this educational activity, you should be better prepared to:
• Describe the mechanistic rationales underlying recent targeted drug development in HCC and how they relate to HCC biology
• Discuss the selection and timing of appropriate locoregional treatment options for patients with HCC, including surgery, ablation, arterially-directed therapies, and radiation therapy
• Evaluate recent clinical trial evidence and patient characteristics to inform optimized sequencing decisions in the management of patients with advanced HCC
• Outline strategies to mitigate the treatment-related toxicities of current and emerging therapies for the management of HCC