The 4th Joint Session between JDDW-KDDW-TDDW4(JDDW)
Thu. November 5th   14:00 - 16:15   Room 10: Portopia Hotel Waraku
JKT4-RS1
 Treatment strategy for unresectable hepatocellular carcinoma with a focus on maintaining hepatic reserve
Yuji Eso
Department of Gastroenterology and Hepatology, Kyoto University Hospital
Transcatheter therapy (transarterial chemoembolization: TACE) and systemic therapy (molecular-targeted therapy: MTA) are the medical treatment options for patients with intermediate/advanced-stage hepatocellular carcinoma (HCC) who are unable to undergo liver resection or radiofreqnency ablation (RFA). About half of all deaths in HCC patients are due to cancer; on the other hand, a high percentage of patients die from liver failure due to worsening liver reserve or complications of cirrhosis. Therefore, it is very important to prevent deterioration of hepatic reserve in the treatment of HCC to improve patient prognosis.
In addition, regorafenib, ramucirumab, and cabozantinib as second-line therapies, and novel first-line regimens, including lenvatinib and the combination of Atezolizumab and bevacizumab, were recently introduced. Systemic therapies such as lenvatinib and atezolizumab plus bevacizumab, which have a high response rate, may offer the possibility of selecting radical therapies such as liver resection or RFA, but this may not be possible if the hepatic reserve is compromised.
In this presentation, we will present the data on HCC patients treated with TACE or Lenvatinib at our institution (Eso et al. Cancers 2019. “Combination of Mac-2 Binding Protein Glycosylation Isomer and Up-To-Seven Criteria as a Useful Predictor for Child-Pugh Grade Deterioration after Transarterial Chemoembolization for Hepatocellular Carcinoma.”/ Eso et al. J Hepatobiliary Pancreat Sci 2020. “Branched-chain amino acid to tyrosine ratio is an essential pre-treatment factor for maintaining sufficient treatment intensity of lenvatinib in patients with hepatocellular carcinoma.”) and discuss strategies for optimizing the treatment of unresectable HCC in anticipation of the advent of combination therapy with MTAs and immune checkpoint inhibitors.
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