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Follow a patient's journey through advanced hepatocellular carcinoma (HCC) and make decisions on treatment selection and sequencing in this interactive patient case video presented by Prof. Sammy Saab.

 

As you interact and engage with valuable information, challenging questions, and clickable resources, you'll choose your preferred 1st line treatment option for a patient who is not eligible for IO, explore how to manage adverse events, and work through the next step after progression on 1st line treatment.

Clinical Takeaways

  • There is a cohort of patients with advanced HCC who are not eligible for immunotherapy as 1st line treatment option
  • This cohort consists of post-transplant recurrent patients or patients who have underlying active or uncontrolled auto-immune disease
  • Tyrosine Kinase Inhibitors (TKIs), such as sorafenib and lenvatinib, would be the preferred 1st line treatment options for these patients
  • Adverse events (AE) management for TKIs can either be dose interruption, reduction or discontinuation, depending on the type and severity of the AE

Educational Objectives

  • Understand the systemic treatment options for patients with advanced & intermediate HCC
  • Know the treatment options for patients with advanced HCC not eligible for immunotherapy in 1st line and implement optimal sequencing
  • Know how to best manage Adverse Events

Sammy Saab, MD is a Professor in the Departments of Internal Medicine and Surgery at the David Geffen School of Medicine in Los Angeles, California, USA. He is also Head of Outcomes Research in Hepatology at the Pfleger Liver Institute. Dr Saab received his BS, MD, and MPH from University of California Los Angeles (UCLA). He completed his residency in internal medicine at University of California at San Diego Medical Center and a fellowship in gastroenterology/hepatology at UCLA Center for Health Sciences. Dr Saab is board certified in gastroenterology and transplant hepatology. He has received honorary fellowships from the American Gastroenterology Association (AGAF), American College of Gastroenterology (FACG) and the American Association for the Study of Liver Diseases (FAASLD). Relevant publications Saab S, Hunt D, Stone MA, McClune A, Tong MJ. Timing of Hepatitis C Antiviral Therapy Pre and Post Liver Transplantation: A Decision Analysis Model. Liver Transpl 2010: 16: 748-59. With accompanying editorial. Duffy JP, Kao K, Ko CY, Farmer DG, McDiarmid SV, Hong JC, Venick RS, Feist S, Goldstein L, Saab S, Hiatt JR, Busuttil RW. Long-term patient outcome and quality of life after liver transplantation: analysis of 20-year survivors. Ann Surg. 2010; 252: 652-61 Saab S, McTigue M, Finn R, Busuttil RW. Sorafenib as adjuvant therapy for high risk Hepatocellular Carcinoma in Liver Transplant Recipients: Feasibility and Efficacy. Exp Clinl Transplant 2010; 8: 307-13. Saab S, Bownick H, Ayoub N, Younossi Z, Durazo F, Han SH, Farmer D, Hong J, Busuttil RW. Differences in Health Related Quality of Life Scores after Orthotopic Liver Transplant with Respect to Selected Socioeconomic Factors. Liver Transpl 2011;17:580-90. Chak E, Talal AH, Sherman KE, Schiff ER, Saab S. Hepatitis C Virus Infection in the United States: An Estimated of the True Prevalence. Liv Intern 2011; 31: 1090-101. Wertheim J, Kupiec-Weglinski J, Petrowsky H, Saab S, Busuttil, RW. Major challenges limiting liver transplantation in the United States. Am J Transplant 2011; 11: 1773-84. Hong JC, Jones CM, Duffy JP, Petrowsky H, Farmer DG, French S, Finn R, Durazo FA, Saab S, Tong MJ, Hiatt JR, Busuttil RW. Comparative analysis of resection and liver transplantation for intrahepatic and hilar cholangiocarcinoma: a 24-year experience in a single center. Arch Surg 2011; 146: 683-9. Everson GT, Terrault NA, Lok AS, Rodrigo DR, Brown RS Jr, Saab S, Shiffman ML, Al-Osaimi AM, Kulik LM, Gillespie BW, Everhart JE; and the A2ALL Study Group. A Randomized Controlled Trial of Pretransplant Antiviral Therapy to Prevent Recurrence of Hepatitis C after Liver Transplantation. Hepatology 2013; 57: 1752-62. Rubin J, Ayoub N, Kaldas F, Saab S. Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review. Exp Clinl Transplant 2012; 10(6):531-43. Sood A, Cox GA, McWilliams JP, Wang HL, Saab S. Patients with Nodular Regenerative Hyperplasia Should be Considered for Hepatocellular Carcinoma Screening. Hepatology Research 2014; 44: 689-93. Matsuda T, Tonnu-Mihara I, Yuan Y, Hines P, Saab S, Italien GJ, McCombs J. External validation of the risk-prediction model for hepatocellular carcinoma [hcc] from the reveal HCV study. Value in Health. 2013; 16: A12. Campsen J, Zimmerman M, Trotter J, Hong J, Freise C, Brown R, Cameron A, Ghobrial M, Kam I, Busuttil R, Saab S, Holt C, Emond J, Stiles J, Lukose T, Chang M, Klintmalm G. Liver transplantation for hepatitis B liver disease and concomitant hepatocellular carcinoma in the United States with hepatitis B immunoglobulin and nucleoside/nucleotide analogues. Liver Transpl 2013; 19: 1020-9. Agopian VG, Petrowsky H, Kaldas FM, Zarrinpar A, Farmer DG, Yersiz H, Holt Cm Harlander-Locke M, Hon JC, Rana AR, Venick R, McDiarmid SV, Goldstein LI, Durazo F, Saab S, Han S, Xia V, Hiatt JR, Busuttil RW. The Evolution of Liver Transplantation During 3 Decades. Analysis of 5347 Consecutive Liver Transplants at a Single Center. Annals of Surgery 2013; 258: 409-21. Saab S, Manne V Akhtar E. Cirrhosis Regression in Hepatitis C Patients with Sustained Virologic Response after Anti-Viral therapy: A Meta-analysis. Liver International 2015; 35: 30-36. Saab S, Manne V, Bui V, Sundaram. Cumulative Radiation Exposure in Liver Transplant Candidates and Patients Transplanted with Hepatocellular Carcinoma. J Liv Dis Transplant 2014; 3 (1). Stepanova M, Wai H, Saab S, Mishra A, Venkatesan C, Younossi ZM. The Portrait of an Adult Liver Transplant Recipient in the United States From 1987 to 2013. JAMA Intern Med 2014; 174: 1407-9. Stepanova M, Wai H, Saab S, Mishra A, Venkatesan C, Younossi Z. The outcomes of adult liver transplants in the united states from 1987 to 2013. Liver Int 2015; 358: 2036-41. Al-hamoudi W, Elsiesy H, Bendahmash A, Al-masri N, Ali S, Allam N, Al Sofayan M, Al Bahili H, Al Sebayel, Dieter Broering M, Saab S, Abaalkhail F. Liver transplantation for hepatitis B virus: Decreasing indication and changing trends. W J Gastroenterol 2015; 21: 8140-7. Saab S, Jimenez M, Fong T, Wu C, El Kabany M, Tong MJ. Timing of Antiviral Therapy in Liver Transplant Candidates listed for Hepatitis C and Hepatocellular Carcinoma. Exp Clin Transpl 2016; 14: 66-71. Al-Hamoudi W, Elsiesy H, Bendahmash A, Al-Masri N, Ali S, Allam N, Al Sofayan M, Al Bahili H, Al Sebayel M, Broering D, Saab S, Abaalkhail F. Liver transplantation for hepatitis B virus: Decreasing indication and changing trends. World J Gastroenterol. 2015; 21:8140-7 Kuei A, Saab S, Cho SK, Kee ST, Lee EW. Effects of Yttrium-90 selective internal radiation therapy on non-conventional liver tumors. World J Gastroenterol. 2015;21:8271-83. Nguyen K, Jimenez M, Moghadam N, Wu C, Farid A, Grotts J, Elashoff D, Choi G, Durazo FA, El-Kabany MM, Han SHB, Saab S. Decrease of Alpha-Fetoprotein in Patients with Cirrhosis Treated with Direct Acting Agents. J Clin Transl Hepatol 2017; 5(1): 43-49. Ahmed A, Gonzalez SA, Cholankeril G, Perumpail RB, McGinnis J, Saab S, Beckerman R, Younossi ZM. Treatment of Patients Waitlisted for Liver Transplant with an All-Oral DAAs is a Cost-Effective Treatment Strategy in the United States. Hepatology 2017; 66(1): 46-56.

Prof. Sammy Saab has received financial support/sponsorship for research support, consultation, or speaker fees from the following companies:

Eisai and Exegesis

Programme summary
  • clock Duration 15 MIN
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Other episodes in this series
Advanced HCC: When to switch to 2nd line treatment

Advanced HCC: When to switch to 2nd line treatment

Explore treatment selection and optimal sequencing after progression on immunotherapy in an interactive patient case video

Advanced HCC: Treatment options for patients ineligible for IO

Advanced HCC: Treatment options for patients ineligible for IO

Explore treatment options, adverse event management and next steps in this interactive patient case

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