What are my options after mixed response to HCC treatment?

Question

Hi doctor,

I have several comorbidities, including type 2 diabetes and hypertension. I was diagnosed with well-differentiated hepatocellular carcinoma (HCC). I have completed four cycles of immunotherapy using Atezolizumab and Bevacizumab; however, recent PET scans and blood tests indicate that my disease is progressing, with a mixed response to treatment.

As a result, my medical team has advised a switch to a new double immunotherapy regimen with Tremelimumab and Durvalumab, and I have just finished my fifth cycle with these new drugs.

Are there any alternative treatment options I should consider? Should I look into genome testing?

I also have the latest results, including a biopsy, my first and most recent PET scan results, alpha-fetoprotein (AFP) levels, PIVKA-II results, and other blood test results.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

First of all, I want to sincerely apologize for your diagnosis of progressive hepatocellular carcinoma (HCC). I fully understand the fear and anxiety this news brings.

I want to reassure you that several immunomodulatory and treatment options are available for HCC that we can explore. These include transarterial chemoembolization (TACE) and transarterial radioembolization (TARE).

Both of these procedures involve delivering chemotherapy or radiation therapy directly to the liver, specifically targeting the disease that is confined within the organ.

These procedures can only be performed under certain conditions. We need to ensure that the liver disease does not have extensive extrahepatic metastases and that your overall health and liver function are suitable for these treatments.

If your general condition does not allow for locoregional therapies, we can consider other types of immunotherapy. There are many different immunotherapy agents available, and new options are continually being developed, providing renewed hope for patients.

In your case, targeted therapy with tyrosine kinase inhibitors (TKIs) is not preferred, as these medications can raise blood pressure, and you already have hypertension. The other aspects of your management plan will not negatively impact your blood pressure or diabetes control.

Supportive management is also a critical component of your care. This may include using anti-nausea medications regularly, taking proton pump inhibitors (like Pantoprazole), eating small, frequent meals, and ensuring adequate fluid and juice intake.

I hope this explanation is clear and helpful. Please feel free to ask any questions at any time; we are always here to support you.