Dr Amit Singal on How HCC Mechanisms Impact Treatment Approaches

Amit Singal, MD, medical director of the Liver Tumor Program and chief of hepatology at UT Southwestern Medical Center, discussed how the etiologies of hepatocellular carcinoma (HCC) and underlying liver function impact treatment strategies. Singal is also a Dedman Family Scholar in Clinical Care and holds the Willis C. Maddrey, MD, Distinguished Chair in Liver Disease.

In a previous interview with The American Journal of Managed Care^®, Singal spoke to HCC risk factors, prevention strategies, the importance of screening in at-risk individuals, and how clinicians should monitor patients in high-risk populations.

Transcript

How do the various mechanisms of HCC impact treatment approaches?

Our current treatment approaches can be quite varied depending on the stage of presentation. And so, when we think of this from a treatment perspective, we need to not only consider how much cancer you have, but also how healthy your underlying liver function is. When we think of certain therapies, like surgical resection, that can be a curative approach if patients are found at an early stage—but this really requires normal liver function. So, patients either have to have the absence of cirrhosis, or if they have cirrhosis, they need to have Child-Pugh A liver disease and the absence of portal hypertension to be eligible for surgical resection.

Conversely, if patients are found at an early stage and they have underlying liver dysfunction, then we have other therapies available, like liver transplantation, which can also offer a cure. But our therapy choices really do consider these different factors together when we think of the optimal treatment for each individual patient. The other aspect that we have to think about is that several of our therapies can favorably impact the underlying tumor, but have some collateral injury to the background liver. When we think of therapies like chemoembolization or radioembolization—which can induce high proportions of response in the tumor—they can have liver dysfunction that happens over time. So, we need to think through once again how healthy the underlying liver function is at baseline and what the expected liver injury could be with any of our individual therapies.