Molecular Target Therapy of HCC

Jordi Bruix  Hospital Clínic, University of Barcelona, Spain

Hepatology Digest: Can you give a brief introduction to your topic at this year's APASL meeting?

Prof. Bruix: I work in a liver cancer group, so all of my talks at APASL are related to liver cancer, from diagnosis, staging, to treatment. The area where there have been more advances is in the area of treatment of cancer-mostly advanced liver cancer. Nowadays, we have Sorafenib as the standard of care and this has opened up the research for new compounds, combinations, and also the use of these agents at earlier stages of the disease. My talks are going to refer to the standard of treatments that we have right now and also where the future is going to bring us in the next few years. Hopefully, it will be better than what we have now.

Hepatology Digest: Has the advent of Sorafenib made your job easier in treating HCC?

Prof. Bruix: The advent of Sorafenib has different consequences. First, this is good news for patients who now have a potential treatment that improves survival. This was not  for patients with advanced cancers and now patients that had no hope can be cured. Second, the efficacy of Sorafenib proves the hope that had been placed in molecular target therapy. So now the concept has been proven that liver cancer is sensitive to these agents now we can expand from there. How to expand? We can expand with combination with second-line treatments. This has made my life easier at first because I have something to treat patients. At the same time, because I do not only daily care, but also clinical research, it has complicated my life because now the area is really very active and there are a lot of initiatives and projects and it is more demanding, but it is also exciting.

Hepatology Digest: I am sure many of our readers are familiar with your work with the ILCA. What is the potential for cooperation with other groups and is their current cooperation with groups such as APASL?

Prof. Bruix: We created the International Liver Cancer Association to prime the different international fields of expertise in different areas of the world. For years liver cancer has been neglected in oncology and mostly dealt with in hepatology units without ever really succeeding in putting together competitive teams with expertise from different areas. In Barcelona we have been successful in putting together a multi-disciplinary team with radiologists, oncologists, surgeons, pathologists, and hepatologists. This success has prompted us to propose an organization that would put people together to develop projects. We have had successful interactions with organizations devoted not only to hepatology, but also to radiology and oncology and we would be more than happy to have partnership and cooperation with APASL. The fields have to be complimentary and team up to have better advancements in research.

Hepatology Digest: Is HCC on the rise in China and the Asia-Pacific region?

Prof. Bruix: More than half of the cases in the world occur in Asia and the majority of those occur in China. So China is a major area of concern in Asia because of liver cancer. The incidence in Asia is stable if not decreasing, but the incidence is increasing in Northern Europe, is stable or slightly increasing in Southern Europe, and increasing in North America and South America. In terms of the current problem it is a major health problem in Asia and there is a need to improve health standards, vaccination programs, establish programs for effective treatment of liver cancer. This is a big effort that is in place in some areas and in others it needs to be improved. Southern Europe has faced the problem for a longer time and is more prepared and the knowledge is already there to get things going. In England and Northern Europe they are on the rise now and they are mounting effective programs and the same is happening in America. As I see it, now people are aware that liver cancer is a problem, they are aware that it can be diagnosed at an early stage, and they are also aware that there are effective therapies. I would say that it is a hot area of clinical practice and research.

Hepatology Digest: What are some of the indications and contraindications of RFA?

Prof. Bruix: If the disease is diagnosed early, there are a few options that can provide a cure. These options are resection, transplantation, and ablation. In transplantation you need organs so this is a limitation for transplantation. Resection can be performed safely in a fraction of the patients and it has morbidity and a potential risk for the patients. It is well known and effective and in earlier stages when tumors are less than 3 cm in size is when radio frequency really competes head to head with surgery. There are no real data to tell for sure that they are the same or one is better than the other. The easy thing about ablation with radio frequency is that it requires a less complicated setting than resection and it can be done in one shot and there is no need for hospital admission, while surgery is more complicated and requires admission and so on. I think that they should no be competitive but they are complementary. In some instances you could try and burn a tumor initially and if there is failure you can use resection. Large tumors will never be able to be completely ablated by radio frequency and they are better served by surgery.