Dr Kim on a Case Study of a Patient With HCC

Richard Kim, MD, service chief, Medical Gastrointestinal Oncology, senior member, the Gastrointestinal Oncology Department, Moffitt Cancer Center; professor, oncology; the University of South Florida College of Medicine, discusses a case study of a patient who presented with hepatocellular carcinoma (HCC), detailing the steps that were taken upon diagnosis.

At an OncLive® State of the Science Summit™ (SOSS) on gastrointestinal cancers, which he chaired, Kim presented a case study involving a 62-year-old man with a complex medical history, including hyperlipidemia, untreated hepatitis C, and past ethanol and intravenous drug abuse, which he had ceased many years prior. This patient arrived at the emergency room with excruciating abdominal pain, coupled with nausea and vomiting, Kim begins. A subsequent CT scan revealed a ruptured mass in the liver. Laboratory investigations indicated low hemoglobin levels, normal platelet counts, and elevated alpha-fetoprotein levels, he explains. The patient was diagnosed with Child-Pugh A liver cirrhosis, as evidenced by bilirubin levels of 1.0 mg/dL and albumin levels of 1.2 g/dL, Kim states.

In response to the bleeding tumor, the medical team performed a blood embolization and obtained a biopsy, confirming the presence of HCC, he expands. The case was then deliberated at a clinic tumor board, Kim says. Although the imaging indicated that the tumor was potentially resectable, there were concerns regarding resection due to the high-risk nature of the case, particularly the ruptured tumor and the limited availability of liver remnants for surgical intervention, he emphasizes. This case predated the advent of immunotherapies. In a hypothetical scenario in 2023, given the high-risk factors of the case and the challenges associated with VEGF inhibitors in the context of bleeding, a plausible treatment choice for this patient could be the combination of durvalumab (Imfinzi) and tremelimumab-actl (Imjudo), supported by the phase 3 HIMALAYA trial (NCT03298451) data indicating a durable response and improved overall survival with this combination in patients with unresectable HCC, Kim notes.

This treatment plan would involve a 3-month course of durvalumab and tremelimumab, with subsequent assessments to gauge the tumor's response, he continues. In the actual case, after an initial period of stability, the patient underwent portal vein embolization, leading to enlargement of the left liver, he states. This enabled a successful surgical intervention to remove the entire right-sided tumor, Kim concludes.