Dr. Sapisochin on Neoadjuvant Treatment for HCC

Gonzalo Sapisochin, MD, assistant professor of surgery, University of Toronto, discusses neoadjuvant treatment for patients with hepatocellular carcinoma (HCC).

It’s important to treat patients while they are awaiting liver transplant to make sure the tumor doesn’t progress in a way that will hinder the procedure, Sapisochin says. Mainly, there are criteria in terms of allowable tumor size heading into the transplant. Unless a living donor is being utilized, patients will go on a waiting list, with the average wait time depending on the hospital’s jurisdiction. Usually, the waiting period will be 6 months to 1 year.

An optimal chemotherapy regimen for this setting is not yet clear. There are ongoing studies looking at this issue, but there has never been a phase III trial comparing “bridging therapies.” The evidence for each therapy is still weak. Sapisochin says the decision relies heavily on Barcelona Clinic Liver Cancer staging, tumor burden, and level of liver disease.