Systemic Treatment in Metastatic HCC

Ghassan K. Abou-Alfa, MD:We have a 70-year-old patient with a good performance status, only affected by the bone, because bone pain is there and that’s why he has an ECOG performance status of 1. And the patient has a Child-Pugh score of A. On his CT-scan, it shows the liver mass and, more importantly, lung and bone metastases evident of metastatic disease. So, clearly, we are talking about metastatic stage 4 liver cancer with a Child-Pugh A score and the choices of therapy here.

It is important to note that the patient has bone metastases. Contrary to what people might think, bone metastases, unfortunately, are relatively common in liver cancer. Based on some research we published recently, close to 28% of the patients with liver cancer might develop bone metastases. So, obviously, this patient has bone metastases and appropriately needs to be treated.

This is a stage 4 metastatic HCC situation. The only approved standard of care at this point in time is sorafenib, which is an appropriate option here for this patient—short of a clinical trial, if it’s available. Sorafenib is given at a standard dose of 400 mg/twice a day—especially for the patient here, who has a good performance of the liver with a Child-Pugh A score.

Transcript edited for clarity.

May 2016

• A 70-year old male with metastatic HCC involving the lung and bone confirmed by biopsy, experiencing mild bone pain
• ECOG=1
• Child-Pugh A
• Therapy was initiated with sorafenib at 400 BID
• Patient experienced grade 1 HTN and grade 1 hand-foot skin reaction, which was managed effectively

April 2017

• Documented radiographic progression
• Therapy with regorafenib at 160mg was initiated
• Patient experienced grade 1 HTN, grade 2 hand-foot skin reaction