Liver Cancer CME ACCREDITED Watch Time: 33 mins

touchMDT Evolving standards of patient care in hepatocellular carcinoma

Select a discussion in the hub to watch our multidisciplinary faculty share their expert perspectives on the management of patients with hepatocellular carcinoma.

Overview & Learning Objectives

An MDT panel discusses evolving standards of patient care in HCC

Medical Oncologist, Radiation Oncologist, Hepatologist, and Surgical Oncologist

A medical oncologist, a radiation oncologist, a hepatologist and a surgical oncologist share their perspectives on a best-practice MDT approach to patient care in the management of HCC.

Expert Spotlight
Prof. Ahmed Kaseb
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Prof. Jinsil Seong
Yonsei University, Seoul, Korea
Prof. Peter Galle
University of Mainz, Mainz, Germany
Dr Michael Choti
Banner MD Anderson Cancer Center, Phoenix, AZ, USA

A medical oncologist, a radiation oncologist, a hepatologist and a surgical oncologist share their perspectives on a best-practice MDT approach to patient care in the management of HCC.

 

Listen on the go

Learn more Back to MDT Hub Time: 10:50
 
Medical Oncologist, Radiation Oncologist, Hepatologist, and Surgical Oncologist

A medical oncologist, a radiation oncologist, a hepatologist and a surgical oncologist discuss how recent developments are enabling the management of patients with HCC to become increasingly individualized.

Expert Spotlight
Prof. Ahmed Kaseb
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Prof. Jinsil Seong
Yonsei University, Seoul, Korea
Prof. Peter Galle
University of Mainz, Mainz, Germany
Dr Michael Choti
Banner MD Anderson Cancer Center, Phoenix, AZ, USA

A medical oncologist, a radiation oncologist, a hepatologist and a surgical oncologist discuss how recent developments are enabling the management of patients with HCC to become increasingly individualized.

 

Listen on the go

Learn more Back to MDT Hub Time: 11:01
 
Medical Oncologist, Radiation Oncologist, Hepatologist, and Surgical Oncologist

A medical oncologist, a radiation oncologist, a hepatologist and a surgical oncologist consider the potential of systemic therapy in HCC during the current immunotherapy era.

Expert Spotlight
Prof. Ahmed Kaseb
The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Prof. Jinsil Seong
Yonsei University, Seoul, Korea
Prof. Peter Galle
University of Mainz, Mainz, Germany
Dr Michael Choti
Banner MD Anderson Cancer Center, Phoenix, AZ, USA

A medical oncologist, a radiation oncologist, a hepatologist and a surgical oncologist consider the potential of systemic therapy in HCC during the current immunotherapy era.

 

Listen on the go

Learn more Back to MDT Hub Time: 11:07
 
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Overview & Learning Objectives
Overview

Join our hepatocellular carcinoma (HCC) multidisciplinary team (MDT) as they discuss the evolving standards of patient care in HCC, including the importance of a multidisciplinary, individualized treatment approach, and the potential of new and emerging systemic therapies.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of medical oncologists, radiologists, surgical oncologists and hepatologists involved in the management of hepatocellular carcinoma.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Ahmed Kaseb discloses: Advisory board/panel fees from AstraZeneca, Bristol Myers Squibb, Eisai, Merck and Roche/Genentech; Consultancy fees from AstraZeneca, Bristol Myers Squibb, Eisai, Merck and Roche/Genentech; and Grants/research support from AstraZeneca, Bayer, Bristol Myers Squibb, Eisai, Exelixis, Merck and Roche/Genentech.

Dr Jinsil Seong has no financial interests/relationships or affiliations in relation to this activity.

Prof. Peter Galle discloses: Consultancy fees from AstraZeneca, Bayer, Bristol Myers Squibb, Ipsen, Lilly, Merck, Sharp & Dohme, Roche, SillaJen and Sirtex Medical.

Dr Michael Choti discloses: Consultancy fees from Merck Sharp & Dohme.

Content reviewer

Olivia Renee Pane, PharmD, CDCES has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Christina Mackins-Crabtree, PhD, CMPP has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 Credit™ by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 30 November 2021. Date credits expire: 30 November 2022.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Analyze the importance of a multidisciplinary approach to patient care in the management of HCC
  • Appraise optimal treatment pathways for individual patients and unmet needs in the management of HCC
  • Evaluate the future role of immune checkpoint inhibitors in the management of HCC
Faculty & Disclosures
Prof. Ahmed Kaseb

The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Ahmed Kaseb, MD, is a Professor and Program Director of Hepatocellular Carcinoma (HCC), in the Department of Gastrointestinal Medical Oncology at the University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Dr Kaseb received his medical degree from Cairo University, and worked as a research fellow at the University of Michigan in Ann Arbor, MI, USA, for two years focusing on cancer biomarkers before starting his internal medicine residency at Wayne State University, Detroit, also in MI, where he excelled in clinical training and was the recipient of The Best Resident Award in 2003–2004. read more

He then finished a medical oncology fellowship at Henry Ford Hospital, Detroit, MI, where he continued his translational research work, which led to three major publications presenting circulating biomarkers for early cancer detection in the area of bladder and prostate cancers and his work on HCC biomarkers was subsequently initiated. Dr Kaseb’s work has received international awards from the American Society of Clinical Oncology (ASCO) and the American College of Physicians (ACP).

Dr Kaseb joined the department of Gastrointestinal Medical Oncology at the University of Texas MD Anderson Cancer Center in 2007 to lead the HCC program. Dr Kaseb is heavily involved in HCC clinical research, where he has served as principal investigator on multiple clinical trials. Dr Kaseb’s principal research interests include HCC systemic and multidisciplinary therapies, in addition to molecular staging studies. His research also examines the differential effects of demographics and hepatitis status on treatment outcomes in HCC. Based on his interests and research, he has developed several protocols in the treatment and staging of HCC. Dr Kaseb’s work has contributed greatly to the understanding of HCC interdisciplinary therapies and molecular staging, and has received governmental and pharmaceutical funding for several projects and clinical trials.

Dr Kaseb has extensively authored and co-authored dozens of papers and books. He also serves as an editor and scientific reviewer for several international medical journals. Dr Kaseb is an active member of several international societies and has served on several committees and advisory boards at national and international levels, and has also participated in several international expert consensus conferences in the area of HCC.

Prof. Ahmed Kaseb discloses: Advisory board/panel fees from AstraZeneca, Bristol Myers Squibb, Eisai, Merck and Roche/Genentech; Consultancy fees from AstraZeneca, Bristol Myers Squibb, Eisai, Merck and Roche/Genentech; and Grants/research support from AstraZeneca, Bayer, Bristol Myers Squibb, Eisai, Exelixis, Merck and Roche/Genentech.

Prof. Jinsil Seong

Yonsei University, Seoul, Korea

Jinsil Seong, MD, PhD, is a Professor in the Department of Radiation Oncology at Yonsei University Medical College in Seoul, Korea. Currently, she is also President of the Asia Pacific Primary Liver Cancer Expert (APPLE) Association and Executive Board member for the Asian Oncology Society. Prof. Seong completed her medical training and PhD at Yonsei University in Seoul, Korea. Prior to her current position, Prof. Seong was a visiting scientist in the Department of Experimental Radiotherapy at MD Anderson Cancer Center in Texas, USA. read more

Prof. Seong maintains active memberships in numerous professional or academic societies, including the National Academy of Medicine of Korea, the International Liver Cancer Association and the Asia Pacific Association for the Study of the Liver. She was awarded the Cancer Prevention Award from the Korean Ministry of Health and Welfare for her contribution on HCC prevention by establishing Liver Cancer Day for the first time in Korea. She received the Adrienne Wilson Liver Cancer Association’s Blue Faery Award for Excellence in Liver Cancer Research for her pioneering work in radiotherapy for HCC, as well as other domestic academic awards (Beum-Suk Best Researcher Award, Joong-Wei Best Academic Award, Yonsei University Medical College Best International Collaboration Award).

Prof. Seong sits on the editorial board for the Journal of Hepatology, has published over 200 journal articles in international peer-reviewed journals, and contributed to several book chapters on the use of radiation therapy. She is a frequent invited speaker at academic conferences and educational events across Asia and the world.

Dr Jinsil Seong has no financial interests/relationships or affiliations in relation to this activity.

Prof. Peter Galle

University of Mainz, Mainz, Germany

Dr Galle, MD, PhD, majored in internal medicine at the Universities of Berlin, Marburg, Mannheim and Heidelberg, Germany, at Hammersmith Hospital, London, UK, as a Fulbright grantee at the University of Texas, USA. He received his MD degree from Marburg University and PhD degree from Heidelberg University, both in Germany. Initially, he held a position as postdoctoral fellow in Molecular Biology at the Centre for Molecular Biology of Heidelberg, working on the replication of hepatitis B viruses. Afterwards, he completed his residency in Internal Medicine and Gastroenterology at the University Hospital of Heidelberg. In 1998, he became director of the Internal Medical Department in Mainz, and from 2005–2008 he was CEO of Mainz University Hospital. read more

He is a member of several national and international societies, such as the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL), has served as co-editor for the Journal of Hepatology and is on the editorial boards of several other journals. He served as congress president of the German Society for Digestive Diseases (DGVS) in 2014. He was a member of the Executive Board and President of the International Liver Cancer Association (ILCA). He was the President of the German Association for the Study of the Liver (GASL) for the year 2020.

His research has focused on elucidating important aspects of apoptotic cell death in the liver, immune escape of tumour cells and on clinical and molecular aspects of HCC. He chaired the panel updating the EASL Clinical Practice Guideline on HCC, which was published in 2018. He has been awarded several prizes, including the prestigious Tannhauser Award, the highest prize of the DGVS. He has published more than 500 peer-reviewed papers.

Prof. Peter Galle discloses: Consultancy fees from AstraZeneca, Bayer, Bristol Myers Squibb, Ipsen, Lilly, Merck, Sharp & Dohme, Roche, SillaJen and Sirtex Medical.

Dr Michael Choti

Banner MD Anderson Cancer Center, Phoenix, AZ, USA

Michael Choti, MD, received his MD degree at Yale University, New Haven, general surgery training at the University of Pennsylvania, Philadelphia, and completed a surgical oncology fellowship at Memorial Sloan-Kettering Cancer Center, New York, before joining the Division of Surgical Oncology at Johns Hopkins, Baltimore. Among his leadership roles, he was the Chair of Surgery at the University of Texas Southwestern Medical Center. Currently, he is the Chief of Surgery at Banner MD Anderson Cancer Center in Phoenix, Arizona, USA. read more

Dr Choti is an active clinician and researcher with an interest in new approaches for the treatment of liver, pancreatic, and colorectal cancer. He has served in various leadership positions in national and international societies and has chaired study sections for the American Cancer Society. He served as chair of the National Cancer Institute’s Cancer Therapy Evaluation Program (NCI-CTEP) Hepatobiliary Task Force and as the director of the National Comprehensive Cancer Network (NCCN) Neuroendocrine Tumor database, as well as serving on the American College of Surgeons Commission on Cancer, the gastrointestinal committees of the National Surgical Adjuvant Breast and Bowel Project (NSABP) and the American College of Surgeons Oncology Group (ACOSOG), and the Colorectal Cancer and Neuroendocrine Tumors Guidelines Panels of NCCN. He has directed educational symposia and served on program committees for the American Society of Clinical Oncology (ASCO), Society of Surgical Oncology (SSO), and American Association for Cancer Research (AACR), among others. He was also a section editor for the Annals of Surgical Oncology, and he has served on the surgical oncology board for the American Board of Surgery.

Dr Michael Choti discloses: Consultancy fees from Merck Sharp & Dohme.

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Question 1/5
In your daily practice treating patients with HCC, which patients do you expect to benefit most from assessment via an MTB?
ALBI, albumin-bilirubin; BCLC, Barcelona Clinic Liver Cancer; HCC, hepatocellular carcinoma; MTB, multidisciplinary tumour board.
Correct

A retrospective cohort study of 6,619 newly diagnosed patients with HCC reported that patients with poor liver function, intermediate or advanced BCLC stage (stage B or C) or high alpha-fetoprotein levels (≥200 ng/mL) benefited most from assessment via an MTB.

Abbreviations

ALBI, albumin-bilirubin; BCLC, Barcelona Clinic Liver Cancer; HCC, hepatocellular carcinoma;  MTB, multidisciplinary tumour board.

Reference

Sinn DH, et al. PLoS One. 2019;14:e0210730.

Question 2/5
The REFLECT randomized phase III non-inferiority trial of lenvatinib versus sorafenib reported which of the following?
Correct

The REFLECT trial reported that median overall survival was 13.6 months (95% CI, 12.1–14.9) in the lenvatinib group and 12.3 months (95% CI, 10.4–13.9; HR, 0.92; 95% CI, 0.79–1.06) in the sorafenib group. Median progression-free was 7.4 (95% CI, 6.9−8.8) versus 3.7 (95% CI, 3.6−4.6; HR 0.66; 95% CI, 0.57−0.77) in the lenvatinib and sorafenib groups, respectively.

Abbreviations

CI, confidence interval; HR, hazard ratio.

Reference

Kudo M, et al. Lancet. 2018;391:1163–73.

Question 3/5
A 52-year-old male is diagnosed with inoperable HCC and is assessed to have a class A Child-Pugh score. What would be your choice of first-line systemic therapy?
HCC, hepatocellular carcinoma.
Correct

The current NCCN guidelines for HCC recommend the use of first line atezolizumab and bevacizumab in patients with a Child-Pugh score of class A. 

Abbreviations

HCC, hepatocellular carcinoma; NCCN, National Comprehensive Cancer Network.

Reference

NCCN. Hepatobiliary Cancers. Version 5.2021. Available at: www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf (accessed 3 November 2021).

Question 4/5
In the initial analysis of the COSMIC-312 phase III trial of cabozantinib plus atezolizumab versus sorafenib in patients with treatment-naive HCC, the risk of disease progress or death in the intent-to-treat population was changed in what way?
HCC, hepatocellular carcinoma.
Correct

In the intent-to-treat population of the COSMIC-312 trial, the risk of disease progress or death was reduced by 37% with the use of cabozantinib plus atezolizumab versus standard-of-care sorafenib (HR, 0.63; 99% CI, 0.44–0.91; p=0.0012).1,2

Abbreviations

CI, confidence interval; HCC, hepatocellular carcinoma; HR, hazard ratio.

References

  1. ClinicalTrials.gov. COSMIC-312 (NCT03755791). 4 June 2021. Available at: https://clinicaltrials.gov/ct2/show/NCT03755791  (accessed 3 November 2021).
  2. OncLive®. Rosa K. 28 June 2021. Available at: www.onclive.com/view/frontline-cabozantinib-plus-atezolizumab-significantly-improves-pfs-in-advanced-hcc (accessed 3 November 2021).
Question 5/5
Assuming future approval and universal reimbursement, in the context of the phase II trials of the combination when treating your patients with HCC with tremelimumab added to durvalumab, which of the following responses would you expect to see?
HCC, hepatocellular carcinoma; TRAE, treatment-related adverse event.
Correct

A phase II trial of durvalumab or tremelimumab monotherapy, or durvalumab in combination with tremelimumab or bevacizumab in advanced HCC reported that:

  • median overall survival observed with tremelimumab plus durvalumab was 18.7 months 
  • the overall response rate observed with tremelimumab plus durvalumab was 24.0%
  • serious adverse events including death ranged from 10.9% up to 24.6% among the four study arms.

Abbreviations

CI, confidence interval; DOR, duration of response; HCC, hepatocellular carcinoma; HR, hazard ratio.

References

  1. ClinicalTrials.gov. NCT02519348. 29 September 2021. Available at: https://clinicaltrials.gov/ct2/show/NCT02519348  (accessed 3 November 2021).
  2. Singh A, et al. Cancers (Basel). 2021;13:2164.
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