Neehar Parikh, MD, medical director, Multidisciplinary Liver Tumor Clinic, medical director, Living Donor Liver Transplantation Program, assistant professor, University of Michigan Health, Michigan Medicine, discusses future research directions in hepatitis C-related hepatocellular carcinoma (HCC).

During the 2021 International Liver Cancer Association Annual Conference, findings from a retrospective cohort study were presented virtually. Moving forward, these analyses could be updated should additional systemic therapies get introduced to the HCC armamentarium to determine whether these agents induce a survival benefit in patients with hepatitis C-related HCC, Parikh says. However, this would be difficult to conduct prospectively at this point. 

Additionally, hepatitis C is becoming an increasingly rare etiologic cause of HCC and cirrhosis because of improved screening and direct-acting antiviral therapies, Parikh explains. 

Although less patients are presenting with viremic hepatitis C, this analysis serves to fulfill an unmet need. Additionally, it remains beneficial to explore other cohort studies to observe patients with active, treated hepatitis C-related HCC to determine how treatment affects outcomes, Parikh concludes.

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Neehar Parikh, MD, discusses future research directions in hepatitis C-related hepatocellular carcinoma. 


Dr. Parikh on Future Research Directions in Hepatitis C-Related HCC 

Neehar Parikh, MD, medical director, Multidisciplinary Liver Tumor Clinic, Living Donor Liver Transplantation Program, assistant professor, Michigan Medicine, University of Michigan, discusses the role of radiation in hepatocellular carcinoma (HCC).

Radiotherapy is still an evolving field, in which most of the data are retrospective, says Parikh. Although stereotactic body radiotherapy (SBRT) is thought to be safe and effective, more data are needed to determine its exact role in the field.

For example, SBRT could be used in patients who may not otherwise be amenable to thermal ablation or some other therapy, such as surgical resection. However, its role in patients with larger tumors is unclear. Additionally, if a patient is eligible for chemoembolization and radiation, it’s not clear which intervention to pursue.

There are some retrospective data that suggest SBRT can be effective in this patient population, but it’s not definitive, says Parikh. Ongoing research may shed light on these questions.

Neehar Parikh, MD, discusses the role of radiation in hepatocellular carcinoma (HCC).

Dr. Parikh on the Role of Radiation in HCC

Neehar Parikh, MD, medical director, Multidisciplinary Liver Tumor Clinic, Living Donor Liver Transplantation Program, assistant professor, Michigan Medicine, University of Michigan, discusses the role of radiation in hepatocellular carcinoma (HCC).

Radiotherapy is still an evolving field, in which most of the data are retrospective, says Parikh. Although stereotactic body radiotherapy (SBRT) is thought to be safe and effective, more data are needed to determine its exact role in the field.

For example, SBRT could be used in patients who may not otherwise be amenable to thermal ablation or some other therapy, such as surgical resection. However, its role in patients with larger tumors is unclear. Additionally, if a patient is eligible for chemoembolization and radiation, it’s not clear which intervention to pursue.

There are some retrospective data that suggest SBRT can be effective in this patient population, but it’s not definitive, says Parikh. Ongoing research may shed light on these questions.

Neehar Parikh, MD, medical director, Multidisciplinary Liver Tumor Clinic, Living Donor Liver Transplantation Program, assistant professor, Michigan Medicine, University of Michigan, discusses criteria for determining transplant eligibility in hepatocellular carcinoma (HCC).

Though transplant eligibility can vary between centers, the Milan Criteria for Liver Transplantation have helped standardize the criteria that are used to assess whether a patient is fit to undergo transplant, explains Parikh.

The criteria for accepting transplant candidates are relatively selective, says Parikh. Other qualifications such as lack of social support and psychosocial issues may render a patient ineligible for transplant.

In some cases, patients who do not meet the standard eligibility criteria are transplanted through living donors or are treated with alternative therapies as a bridge to transplant, concludes Parikh.

Neehar Parikh, MD, discusses criteria for determining transplant eligibility in hepatocellular carcinoma.

Dr. Parikh on Determining Transplant Eligibility in HCC

Neehar Parikh, MD, medical director, Multidisciplinary Liver Tumor Clinic, Living Donor Liver Transplantation Program, assistant professor, Michigan Medicine, University of Michigan, discusses the importance of multidisciplinary care in the treatment of patients with hepatocellular carcinoma (HCC).

Patients with HCC are commonly treated by a multidisciplinary team in the university setting, says Parikh. These groups consist of hepatologists, interventional radiologists, oncologists, diagnostic radiologists, and palliative care specialists, says Parikh.

These teams work as a single unit to optimize treatment for patients and address any complications that arise, says Parikh.

Importantly, analyses suggest that there is a survival advantage when patients who receive curative intent therapy are treated by a multidisciplinary team compared with those treated by a single physician, concludes Parikh.

Neehar Parikh, MD, discusses the importance of multidisciplinary care in the treatment of patients with hepatocellular carcinoma.

Neehar Parikh, MD

Articles

Dr. Parikh on Future Research Directions in Hepatitis C-Related HCC

Dr. Parikh on the Role of Radiation in HCC

Dr. Parikh on the Role of Radiation in HCC

Dr. Parikh on Determining Transplant Eligibility in HCC

Dr. Parikh on the Importance of Multidisciplinary Care in HCC