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Accreditation/ Credit Designation

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. These activites are not approved for AMA PRA Category 1 Credit™.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from Bayer HealthCare Pharmaceuticals Inc.


Medical Crossfire®: Bridging Emerging Data to Advance Treatment Planning for Hepatocellular Carcinoma: A Multidisciplinary Tumor Board PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap



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Considerations in the Management of Curable Hepatocellular Carcinoma

The online Medical Crossfire® CME activity, Bridging Emerging Data to Advance Treatment Planning for Hepatocellular Carcinoma: A Multidisciplinary Tumor Board, provides oncologists and other practitioners with an engaging multidisciplinary discussion from several leading hepatocellular carcinoma (HCC) experts, including Ghassan K. Abou-Alfa, MD, medical oncologist on the Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center; Jeff Geschwind, MD, chairman of the Department of Radiology and Biomedical Imaging and professor of radiology and oncology at Yale School of Medicine; T Peter Kingham, MD, FACS, associate attending surgeon on the Hepatopancreatobiliary Service and director of global cancer disparity initiatives at Memorial Sloan Kettering Cancer Center; and Stacey M. Stein, MD, assistant professor of medicine (medical oncology) at Yale School of Medicine. This first of 3 PER Pulse™ Recaps from this program focuses on important considerations for the optimal management of curable HCC.

Dr Kingham presented data from studies using resection as a curative approach for HCC and provided his insights on this topic:

  • A retrospective study of 212 patients who underwent resection showed that 50 patients survived more than 10 years, suggesting that resection can be curative in this population.
  • Resection and ablation in early-stage disease can both produce excellent outcomes, particularly in patients with small tumors. Ablation is especially useful in patients with tumors smaller than 2 cm and in those unfit for surgery, whereas resection may be preferred in patients with larger tumors.
  • One of the primary decisions for patients with curable HCC is whether transplantation or resection is the best approach. Transplantation has the advantage of treating both the HCC and the parenchymal disease, but its use is limited by the disease extent that it can treat and the availability of transplant organs. Resection, on the other hand, is more widely applicable and has no limitations on tumor size; however, it does not address the diseased liver remnant. Moreover, liver regeneration may be impaired in patients with cirrhosis. Both approaches have similar 5-year overall survival rates of 77% to 78%.
  • A retrospective study of 193 patients showed that those with tumors larger than 10 cm have similar outcomes compared with patients having smaller tumors, demonstrating that resection of large tumors can lead to long-term survival.

Following Dr Kingham’s presentation, the multidisciplinary panel discussed resection versus transplant and the important considerations of each approach, the use of ablation or chemoembolization to bring patients within Milan criteria, the predictive ability of Milan criteria, and the lack of roles of adjuvant/neoadjuvant therapies at the current time. Dr Geschwind also challenged Dr Kingham regarding their differing views on the role of surgery in patients with small HCC tumors.

For additional commentary about these topics and others, visit www.gotoper.com for archived video of the Medical Crossfire® CME activity, Bridging Emerging Data to Advance Treatment Planning for Hepatocellular Carcinoma: A Multidisciplinary Tumor Board.



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PER Pulse™ Recap

Role of Locoregional Therapies in Locally Advanced Hepatocellular Carcinoma

The online Medical Crossfire® CME activity, Bridging Emerging Data to Advance Treatment Planning for Hepatocellular Carcinoma: A Multidisciplinary Tumor Board, provides oncologists and other practitioners with an engaging multidisciplinary discussion from several leading hepatocellular carcinoma (HCC) experts, including Ghassan K. Abou-Alfa, MD, medical oncologist on the Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center; Jeff Geschwind, MD, chairman of the Department of Radiology and Biomedical Imaging and professor of radiology and oncology at Yale School of Medicine; T Peter Kingham, MD, FACS, associate attending surgeon on the Hepatopancreatobiliary Service and director of global cancer disparity initiatives at Memorial Sloan Kettering Cancer Center; and Stacey M. Stein, MD, assistant professor of medicine (medical oncology) at Yale School of Medicine. This second of 3 PER Pulse™ Recaps from this program focuses on the role of locoregional therapies in the management of locally advanced HCC.

Dr Geschwind provided his opinions about the role of chemoembolization in locally advanced HCC and factors that should guide its use:

  • Transarterial chemoembolization (TACE) can be useful in patients with Barcelona clinic liver cancer stage C (BCLC C) disease, as demonstrated by an Austrian trial in which TACE compared favorably with sorafenib.
  • TACE produced good outcomes in patients with disease that was between BCLC stage B (BCLC B) and BCLC C (quasi-C), showing a median survival similar to that of patients with BCLC B disease.
  • The Hong Kong Liver Cancer staging system should replace the BCLC staging system because it can outperform BCLC, particularly for patients with stage 3b disease (locally invasive liver cancer).
  • A recent study showed that outcomes with conventional TACE were similar to drug-eluting bead TACE. An interesting observation from this study was the fact that conventional TACE produced outcomes similar to those produced by sorafenib in the SHARP trial.
  • Although the addition of sorafenib to TACE in patients with intermediate-stage HCC in the SPACE trial did not show an improvement in survival, the Asian cohort showed some evidence of improvement (although nonsignificant). Dr Geschwind suggested this was due to the fact that aggressive side-effect management allowed them to adhere more closely to the sorafenib protocol than the non-Asian cohort. These data are supported by 1 nonrandomized study and several retrospective studies.

Following Dr Geschwind’s presentation, faculty members had a lively multidisciplinary discussion of the utility of locoregional therapies to treat the quasi-C cohort of patients, the relative benefit of embolization versus surgery in patients with borderline BCLC stage A/B disease, the limitations of the current BCLC categorization of patients, and the use of TACE plus sorafenib as a bridge to transplant.

For additional commentary about these topics and others, visit www.gotoper.com for archived video of the Medical Crossfire® CME activity, Bridging Emerging Data to Advance Treatment Planning for Hepatocellular Carcinoma: A Multidisciplinary Tumor Board.


3 of 3
PER Pulse™ Recap

Systemic Therapies for Advanced Hepatocellular Carcinoma

The online Medical Crossfire® CME activity, Bridging Emerging Data to Advance Treatment Planning for Hepatocellular Carcinoma: A Multidisciplinary Tumor Board, provides oncologists and other practitioners with an engaging multidisciplinary discussion from several leading hepatocellular carcinoma (HCC) experts, including Ghassan K. Abou-Alfa, MD, medical oncologist on the Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center; Jeff Geschwind, MD, chairman of the Department of Radiology and Biomedical Imaging and professor of radiology and oncology at Yale School of Medicine; T Peter Kingham, MD, FACS, associate attending surgeon on the Hepatopancreatobiliary Service and director of global cancer disparity initiatives at Memorial Sloan Kettering Cancer Center; and Stacey M. Stein, MD, assistant professor of medicine (medical oncology) at Yale School of Medicine. This third of 3 PER Pulse™ Recaps from this program focuses on a discussion of current and emerging therapies for the treatment of patients with advanced HCC.

Dr Stein discussed data from the pivotal trials for both sorafenib (SHARP trial) and regorafenib (RESORCE trial) before moving into a discussion of emerging data with immune therapy in HCC. Below are some highlights of her presentation:

  • Results from the pivotal SHARP trial demonstrated that sorafenib, a multitargeted tyrosine kinase inhibitor (TKI), produced a 2.8-month improvement in median overall survival (OS) compared with placebo in patients with advanced HCC. Sorafenib remains the standard of care for first-line advanced HCC.
  • Results from the RESORCE trial showed that regorafenib, another TKI, was associated with a significant improvement in median OS (2.8 months; HR, 0.63) compared with placebo in second-line HCC in patients who tolerated first-line sorafenib but progressed on that regimen. Since the taping of this Medical Crossfire®, regorafenib received approval from the FDA (April 27, 2017) for this indication, becoming the first FDA-approved agent in HCC since sorafenib’s approval in 2007.
  • Dr Stein pointed out that both clinical trials largely focused on patients with Child-Pugh A disease and that more research is needed to learn how patients with Child-Pugh B or C disease will respond to these agents. The GIDEON Registry compiles data on the real-world use of sorafenib in this patient population.
  • Immune checkpoint inhibitors are under investigation in HCC, with the PD-1 inhibitor nivolumab reporting an 18.6% response rate in the phase 1/2 CheckMate-040 trial in patients who were either treatment naïve or had received prior sorafenib. Several other checkpoint inhibitors are being evaluated in first- and second-line HCC trials.

Following Dr Stein’s presentation, the multidisciplinary panel discussed the balance between the benefit of TKI therapy and the toxicities associated with it, the problem that many patients with advanced HCC are not eligible for clinical trials due to their underlying liver disease, the promise of immune therapy agents, and the need for additional advances before any therapies can realistically be used neoadjuvantly to impact tumor resectability.

For additional commentary about these topics and others, visit www.gotoper.com for archived video of the Medical Crossfire® CME activity, Bridging Emerging Data to Advance Treatment Planning for Hepatocellular Carcinoma: A Multidisciplinary Tumor Board.





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