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Beyond the Guidelines: Investigator Perspectives on Current Clinical Issues and Ongoing Research in the Systemic Treatment of Hepatocellular Carcinoma
Released March 2018

Proceedings from a CME symposium held at the 2018 Gastrointestinal Cancers Symposium. Featuring perspectives from Drs Ghassan Abou-Alfa, Josep M Llovet, Bert H O'Neil and Andrew X Zhu. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for medical oncologists, hematology-oncology fellows, surgeons and other healthcare providers involved in the treatment of hepatocellular carcinoma (HCC).

    HCC, the most common form of liver cancer, is a major cause of mortality globally, resulting in an estimated 600,000 deaths per year. The incidence rate of liver cancer in the United States has increased sharply, and it is estimated that approximately 42,220 new cases will be diagnosed in 2018 in this country and 30,200 individuals will die of the disease. Initial management is generally multidisciplinary in nature, and several potentially curative treatment modalities are available for patients with early-stage HCC. Unfortunately, for a number of reasons (eg, tumor extent, underlying liver dysfunction) many patients may not be amenable to potentially curative efforts, and median survival from time of diagnosis remains less than 1 year. This dismal prognosis has created the dramatic need for other therapeutic interventions and has spurred a rigorous research platform spanning several decades and most recently resulting in a number of new FDA approvals and various Phase III clinical trials.

    Several consensus- and evidence-based treatment guidelines are available and aim to assist clinicians with making HCC management decisions in this dynamic clinical and research environment. However, in situations where multiple acceptable therapeutic options exist, such guidelines may not be particularly helpful at the time of decision-making. By exploring the perspectives of leading investigators regarding a number of clinical scenarios and reviewing key data sets, this activity will assist medical oncologists and other healthcare professionals in the development of evidence-based strategies for the treatment of HCC.


    • Develop evidence-based strategies to properly diagnose and stage HCC, and use this information to counsel patients regarding their long-term prognosis.
    • Consider age, performance status, liver function and other clinical and logistical factors in the selection and sequencing of available systemic agents for patients with unresectable or metastatic HCC.
    • Develop an understanding of the biologic rationale for and available clinical data with anti-PD-1 and/or anti-PD-L1 antibodies in the treatment of HCC.
    • Appraise available Phase III data with and consider the potential clinical role of cabozantinib for patients with disease progression on sorafenib.
    • Counsel patients regarding the incidence and manifestation of side effects and toxicities associated with existing and emerging targeted agents and immunotherapeutic approaches used in the management of advanced HCC.
    • Recall available and emerging data with other investigational agents currently in clinical testing for HCC, and, where applicable, refer eligible patients for trial participation or other expanded access programs.

    Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    CME credit is no longer available for this issue

    CME credit is no longer available for this issue

    This CME activity consists of a video component.
    CME credit is no longer available for this issue

    Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess conflicts of interest with faculty, planners and managers of CME activities. Conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

    FACULTY — The following faculty (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Ghassan Abou-Alfa, MD
    Medical Oncologist
    Memorial Sloan Kettering Cancer Center
    New York, New York

    Consulting Agreements: Agios Pharmaceuticals Inc, Amgen Inc, Aptus Clinical, ASLAN Pharmaceuticals, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Boston Scientific Corporation, Bristol-Myers Squibb Company, CARsgen Therapeutics, CASI Pharmaceuticals, Celgene Corporation, CytomX Therapeutics, Daiichi Sankyo Inc, Debiopharm Group, Delcath Systems Inc, Eisai Inc, Gilead Sciences Inc, Halozyme Inc, Inovio Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Lilly, MedImmune Inc, Merck, Onxeo, PCI Biotech, Roche Laboratories Inc, Sanofi Genzyme, Servier, Silenseed Ltd, SillaJen, Sirtex Medical Ltd, Yakult Pharmaceutical Industry CO LTD; Contracted Research: Agios Pharmaceuticals Inc, Array BioPharma Inc, AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, CASI Pharmaceuticals, Celgene Corporation, Exelixis Inc, Genentech BioOncology, Incyte Corporation, Lilly, MabVax Therapeutics Holdings Inc, MedImmune Inc, Momenta Pharmaceuticals Inc, Novartis, OncoMed Pharmaceuticals Inc, Roche Laboratories Inc.

    Josep M Llovet, MD, PhD
    Professor of Medicine
    Director, Mount Sinai Liver Cancer Program
    Division of Liver Diseases, Tisch Cancer Institute
    Icahn School of Medicine at Mount Sinai
    New York, New York
    Professor of Research - ICREA
    Director, Master in Translational Medicine
    BCLC Group, Liver Unit, CIBERehd, IDIBAPS
    Hospital ClĂ­nic de Barcelona
    University of Barcelona
    Barcelona, Spain

    Advisory Committee: Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Lilly; Consulting Agreements: Bayer HealthCare Pharmaceuticals, Blueprint Medicines, Bristol-Myers Squibb Company, Celsion Corporation, Eisai Inc, Incyte Corporation, Lilly; Contracted Research: Bayer HealthCare Pharmaceuticals, Blueprint Medicines, Bristol-Myers Squibb Company, Eisai Inc, Incyte Corporation.

    Bert H O'Neil, MD
    Professor of Medicine
    Director, Phase I and GI Malignancies Programs
    Indiana University Simon Cancer Center
    Indianapolis, Indiana

    Advisory Committee: Amgen Inc, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Celgene Corporation; Speakers Bureau: Bayer HealthCare Pharmaceuticals, Halozyme Inc.

    Andrew X Zhu, MD, PhD
    Director, Liver Cancer Research
    Massachusetts General Hospital Cancer Center
    Professor of Medicine
    Harvard Medical School
    Boston, Massachusetts

    Advisory Committee: AstraZeneca Pharmaceuticals LP, Bayer HealthCare Pharmaceuticals, Bristol-Myers Squibb Company, Eisai Inc, Lilly, Merck, Novartis, Sanofi Genzyme; Contracted Research: Bayer HealthCare Pharmaceuticals, Lilly, Merck, Novartis.

    MODERATOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Acerta Pharma, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Baxalta Inc, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, CTI BioPharma Corp, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sanofi Genzyme, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals Inc.

    RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no relevant conflicts of interest to disclose.

    This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

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

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
    Adobe Flash Player 27 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Last review date: March 2018
    Expiration date: March 2019

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