Ghassan K. Abou-Alfa, MD: That really brings us to final thoughts that I would like to bring up from all our discussants. I would like to start with you, Catherine, because you just heard about so many variable new therapies. At the same time, you nicely explained to us and tried to clarify to us the necessity of looking at the liver. But what do we learn from this? Now it’s 2018. Like what do we learn from all this information?

Catherine Frenette, MD: To me, the most important thing to remember through all of this is that this is a multidisciplinary disease management that we need to have, especially as we’re talking about all of these different new systemic therapies and trying to figure out where they’re going to fall in the treatment of the patient. I like how Anthony has said developing the treatment plan for the patient. This isn’t a, “Oh, hi, how are you, here’s your case, OK, here’s some sorafenib.” We really need to talk about a treatment plan, and that really needs to involve all of the different specialists so that we can really have the best outcomes for our patients.

Ghassan K. Abou-Alfa, MD: Nicely said, I totally agree. Anthony, your thoughts?

Anthony El-Khoueiry, MD: Well, it’s an exciting time, and it’s an exciting time for the field, but it’s also most important that we’re seeing more benefit for patients for this difficult disease that’s rising in incidence. I think we have the responsibility though as physicians in different specialties to really come together even more, and really try and understand where the benefit of our various therapies starts and ends. How do we use them more appropriately in the different stages of the disease? How do we combine them? Now that we have options, the responsibility has become higher. So, we just have to do this. This is what I see as the next challenge for us in the disease. The other aspect, I think we have more responsibility in biomarker development. You touched on that.

There are certain clinical parameters that we may learn may influence our choices over time, like AFP, and etiology, etc. But I think also molecular biomarkers are going to be important in the future. Because as we get more therapies, we want to be a bit smarter about giving the right drug to the right patient. Easier said than done I understand, but it certainly should be a goal, and that requires actually patients to also be willing to undergo biopsies and to have tissue studied.

Ghassan K. Abou-Alfa, MD: Very nicely said. Ruth, any final thoughts or comments?

A. Ruth He, MD, PhD: Yes. So, as the team, the group, has mentioned a couple of times, this is really 2 diseases: HCC and cirrhosis liver failure. I think also attention should be put on how to preserve the liver function and look at the real liver toxicities of each treatment modalities, and really come up with a strategy that would cause tumor shrinkage, long-time disease control, and without hurting the liver.

Ghassan K. Abou-Alfa, MD: That is very important. If anything, you heard from all of us in regard to the critical importance of the multidisciplinary team approach that’s necessary to make sure that we help benefit the patients in the best possible way. We also heard about the point of Dr. El-Khoueiry in regard to the need for the biomarkers. The good news is that we are currently doing an effort globally to collect tissue from different cohorts of patients in regard to specific etiologies, specific ethnicity, and the specific other defined aspects, and try to understand it from the DNA, RNA, and 14-level, and try to analyze the data accordingly and decide who will benefit most from being on either tyrosine kinase inhibitor or a checkpoint inhibitor, as we just heard of the many choices that we have currently.

I would like to thank you all for your contributions to this discussion. And on behalf of our panel, I would like to thank you for joining us, and we hope you find this Peer Exchange^® discussion to be useful and informative.

Transcript Edited for Clarity