Treatment Sequencing in a Patient With Advanced HCC - prIME Oncology
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Treatment Sequencing in a Patient With Advanced HCC

A Case-Based Educational Series: Case Two of Three

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Explore the options in hepatocellular carcinoma (HCC) treatment. Virtual HCC eCases deliver concise, interactive, clinical scenarios along with data to support different decision points throughout the patient’s disease course. Each case covers different aspects of the treatment of patients with HCC.

Interactive Presentation

Interactive Presentation



0.25 AMA PRA Category 1 Credit

Release Date

Release Date

May 24, 2018

Expiration Date

May 24, 2019

A 59-year-old seafarer with hepatitis C (HCV)-related cirrhosis was diagnosed with metastatic hepatocellular carcinoma (HCC) and is referred to you for treatment consideration.

The patient has a 3-month history of progressive malaise and intermittent abdominal pain. Four years ago, he was treated for HCV infection with interferon and was under surveillance. He then moved for work to another country and failed to continue with surveillance. Physical exam revealed: Hepatomegaly 5 cm below costal margin; no ascites, jaundice or encephalopathy; no cutaneous stigmata of chronic liver disease; and multiple tattoos. His body mass index (BMI) is 23 mg/m2. His laboratory results reveal complete blood count (CBC), albumin, bilirubin, prothrombin time, and renal function are normal; aspartate aminotransferase (AST) is 95 units/L, and alanine aminotransferase (ALT) is 67 units/L.

  • Ghassan Abou-Alfa, MD, MBAMemorial Sloan Kettering Cancer Center
    New York, New York, United States

This activity is designed for medical oncologists and other healthcare professionals involved in the management of HCC.

After successful completion of this educational activity, participants should be able to:

  • Select appropriate locoregional and/or systemic treatment strategies for individual patients with HCC based on recent trial data and evidence-based guidelines
  • Determine patterns of treatment sequencing in patients with unresectable HCC and Identify emerging, including new targeted therapies and immunotherapies, and discuss how these therapies may be incorporated into the treatment algorithm

Case 1

A 56-year-old, obese male with type II diabetes is referred to you due to ultrasound (US) findings of “fatty liver” and 5 concerning lesions in the right liver lobe.

The patient stated that he had a blood work done a month ago that showed abnormal liver enzymes and low platelets. He has had a history of obesity since childhood and diabetes for more than 10 years. His blood sugar is currently well controlled with therapy. He denies excessive alcohol intake or the use of any dietary supplements. His family history is significant for obesity, diabetes, and hypertension.

Results from a physical exam show central obesity (body mass index [BMI] 35 mg/m2) and palpable liver 3 cm below the costal margin. Laboratory results reveal decreased platelets count (120 x 109/L), elevated transaminases (alanine aminotransferase [ALT] 67 U/L, aspartate aminotransferase [AST] 97 U/L), and an alpha-fetoprotein (AFP) level of 115 mg/L. Other blood and biochemistry results are within normal limits. Serologies for hepatitis B (HBV) and hepatitis C (HCV) are negative. His Eastern Cooperative Oncology Group (ECOG) performance status (PS) is 1…

Click to View Case 1

Case 3

A 55-year-old, female, nurse with chronic hepatitis C (HCV)-related cirrhosis underwent regular screening with ultrasound, the results of which showed 2 lesions (2.5 cm and 1.5 cm) in the right and the left liver lobe, as well as moderate ascites. Triphasic contrast-enhanced computed tomography (CT) results revealed arterial enhancement with venous washout, without portal vein thrombosis or vascular invasion. There was no evidence of extrahepatic disease. The patient reported intermittent fatigue doing household chores. Results from physical examination revealed mild, bilateral, lower extremity, pitting edema and clinical signs of ascites. Upper gastrointestinal endoscopy results showed esophageal varices grade 1.

Click to View Case 3

This educational activity is supported by grants from Bayer HealthCare Pharmaceuticals, Inc. and Eisai.

Continuing Education

prIME Oncology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Treatment Sequencing in a Patient With Advanced HCC - prIME Oncology

prIME Oncology designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


This activity is provided by prIME Oncology.

Disclosure Information

Method of Participation

There are no fees for participating in and receiving CME credit for this activity. In order to receive credit, participants must successfully complete the online posttest and activity evaluation. Your participation in this CME activity will be recorded in prIME Oncology’s database. However, upon request, your CME credit certificate will be emailed to you. Technical requirements may be found under the Terms of Use.

Links to the posttest are available on the video player pages.

In order to receive credit, participants must successfully complete the online posttest with 75% or higher.

Disclosure of Relevant Financial Relationships

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Dr Abou-Alfa has disclosed that he has received consulting fees from Agios Pharmaceuticals; Amgen; Aptus Pharmaceuticals, Inc.; ASLAN Pharmaceuticals; Astellas Pharma Inc.; AstraZeneca; Bayer; Bristol-Myers Squibb; Boston Scientific Corporation; CARsgen Therapeutics; CASI Pharmaceuticals, Inc.; Celgene Corporation; CytomX Therapeutics; Daiichi Sankyo; Debiopharm Group; Delcath Systems Inc.; F. Hoffmann-La Roche Ltd.; Gilead Sciences, Inc.; Halozyme, Inc.; Inovio Pharmaceuticals, Inc.; Ipsen; Merck & Co., Inc.; MedImmune; Onxeo; PCI Biotech; Sanofi-Aventis; Servier; Silenseed; SillaJen Inc; Sirtex; and Yakult Pharmaceutical Industry. He has received grant/research support from Agios Pharmaceuticals; Array BioPharma; AstraZeneca; Bayer; Bristol-Myers Squibb; CASI Pharmaceuticals, Inc.; Celgene Corporation; Exelixis; F. Hoffmann-La Roche Ltd.; Genentech, Inc.; Incyte Corporation; Lilly; MabVax Therapeutics Holdings, Inc.; MedImmune; Momenta Pharmaceuticals; and OncoMed Pharmaceuticals (research support to institution).

He has agreed to disclose any unlabeled/unapproved uses of drugs or products referenced in his presentation.

The employees of prIME Oncology have disclosed:

  • Bojana Pajk, MD, MSc (medical director content reviewer/planner) – no relevant financial relationships
  • Briana Betz, PhD (scientific content reviewer/planner) – no relevant financial relationships
  • Trudy Stoddert, ELS (editorial content reviewer) – no relevant financial relationships


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Disclosure Regarding Unlabeled Use

This activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration or European Medicines Agency. Please refer to the official prescribing information for each product discussed for discussions of approved indications, contraindications, and warnings.