Ghassan K. Abou-Alfa, MD: Hello, and thank you for joining this OncLive Peer Exchange^® titled “Expanding the Armamentarium in Metastatic Liver Cancer.” This past year brought 2 new drug approvals in advanced liver cancer following a drought of nearly 10 years. In addition, promising new data suggest more additions to the treatment landscape are around the corner. This OncLive^® global Peer Exchange^® panel of experts in liver cancer will discuss the best practices with the currently available therapies in the setting of metastatic disease. We will also bring you up to speed on emerging therapies and novel combination therapies.

I am Dr. Ghassan Abou-Alfa. I’m a medical oncologist at Memorial Sloan Kettering Cancer Center in New York. Participating today on our distinguished panel are: Dr. Anthony El-Khoueiry, associate professor of clinical medicine at the University of Southern California Norris Comprehensive Cancer Center in Los Angeles, California; Dr. Catherine Frenette, hepatologist and medical director of Liver Transplantation and director of the Hepatocellular Carcinoma Program at Scripps Green Hospital at La Jolla, California; and Dr. Ruth He who is associate professor of medicine and a hematology/oncology specialist at Georgetown University Medical Center in Washington, DC. And joining us later in the series will be Dr. Riccardo Lencioni, professor of clinical radiology at the University of Miami Miller School of Medicine and director of Interventional Radiology Research at the Sylvester Comprehensive Cancer Center in Miami, Florida. Thank you so much for joining us, and let’s begin.

So, thank you very much, everybody. It’s so nice to see you all, and I would like to really start the discussion by setting up the ground to hepatocellular carcinoma. Like what is it, how common is it, who are those patients. Maybe Catherine can help to discuss that.

Catherine Frenette, MD: Absolutely. Hepatocellular carcinoma in the United States is becoming a bigger and bigger problem. In the past 30 years, it has more than tripled in incidence and prevalence, and it’s now among the top 10 reasons for death in the United States. A lot of the reason for that is because of cirrhosis. In patients who have cirrhosis, they have a risk of developing liver cancer as high as 3% to 8% per year depending on the etiology. So, we’re seeing more patients with cirrhosis. The hepatitis C epidemic is now maturing to where up to 25% of patients with hepatitis C have underlying cirrhosis. And we’re also seeing a huge rise in fatty liver-related cirrhosis, with a giant rise in hepatocellular carcinoma related to fatty liver disease.

Ghassan K. Abou-Alfa, MD: You bring an important point over here, and if I were to dissect this a little bit further, you mention the word “silent epidemic” and you’re absolutely right. It was always silent. But now we understand that there’s a new advent of therapy for hepatitis C. On the other hand, you mentioned about the clear contribution of the fatty liver disease related to the obesity and diabetes, I assume, and no doubt that we are seeing a rise there, as you just mentioned. My question is, are we seeing a certain balance between some decline and some rise or is it still on the rise altogether because of the fatty liver disease?

Catherine Frenette, MD: So, overall, it is definitely still on the rise. We are seeing a little bit of a shift in the disease etiology, where as patients are getting treated for their hepatitis C, we do know that that actually decreases the risk of cancer by about half in those patients. However, we’re seeing a big rise in fatty liver-related liver cancer, and there are actually places in the United States where fatty liver has now overtaken hepatitis C as the No. 1 cause for liver-related death and liver cancer.

Ghassan K. Abou-Alfa, MD: Incredible, incredible. Ruth, let’s take it from the perspective of oncology. How much of the risk factor or the etiology being hepatitis B, or hepatitis C, or alcohol, or fatty liver disease will play a role in regard to the management? Do you really see any role or any importance to the risk factor in regard how you treat the patients or how the patients will have a certain outcome?

A. Ruth He, MD, PhD: So, currently, all of the treatments for hepatocellular carcinoma are not different for patients with different etiology. And patients who have cirrhosis tend to have, they could have later liver decompensation. And patients with hepatitis B-induced HCC, sometimes those patients may not have severe cirrhosis with liver decompensation.

Ghassan K. Abou-Alfa, MD: That’s great that you bring this up because, no doubt, that if anything at the moment, it’s like an all-in-one basket in regard to the understanding, even though some suggestions in regard to therapy—which we’re going to talk about a little bit later—will tell us that, probably after all we’re getting with the different diseases. But you’re right, from the start of the process until the cancer per se, they can differ. But then afterwards, at least the best understanding we have is that the same process maybe was different in delay in regard to the different aspects of the evolution of the disease, per se.

Transcript Edited for Clarity