EASL-EORTC clinical practice guidelines : management of hepatocellular carcinoma

The release of negative regulators of immune activation (immune checkpoints) that limit antitumor responses has resulted in unprecedented rates of long-lasting tumor responses in patients with a variety of cancers. This can be achieved by antibodies blocking the cytotoxic T lymphocyte–associated protein 4 (CTLA-4) or the programmed cell death 1 (PD-1) pathway, either alone or in combination. The main premise for inducing an immune response is the preexistence of antitumor T cells that were limited by specific immune checkpoints. Most patients who have tumor responses maintain long-lasting disease control, yet one-third of patients relapse. Mechanisms of acquired resistance are currently poorly understood, but evidence points to alterations that converge on the antigen presentation and interferon-γ signaling pathways. New-generation combinatorial therapies may overcome resistance mechanisms to immune checkpoint therapy.

Cancer immunotherapy using checkpoint blockade

Side Effects of Immune Checkpoint Blockade The wide range of immune-related adverse effects associated with immune checkpoint blockade can complicate this effective therapy and limit its use in patients with cancer. This review surveys the adverse effects and their management.

https://www.nejm.org/doi/pdf/10.1056/NEJMra1703481

Immune-Related Adverse Events Associated with Immune Checkpoint Blockade

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.29913

Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases

Rapid improvements in sequencing and array-based platforms are resulting in a flood of diverse genome-wide data, including data from exome and whole-genome sequencing, epigenetic surveys, expression profiling of coding and noncoding RNAs, single nucleotide polymorphism (SNP) and copy number profiling, and functional assays. Analysis of these large, diverse data sets holds the promise of a more comprehensive understanding of the genome and its relation to human disease. Experienced and knowledgeable human review is an essential component of this process, complementing computational approaches. This calls for efficient and intuitive visualization tools able to scale to very large data sets and to flexibly integrate multiple data types, including clinical data. However, the sheer volume and scope of data pose a significant challenge to the development of such tools.

Integrative Genomics Viewer

Nivolumab (Nivo) in Patients (Pts) With Advanced Hepatocellular Carcinoma (HCC): the CheckMate 040 Study

404 Background: Epidermal growth factor receptor (EGFR) pathway activation or over-expression plays an important role both in cirrhosis and hepatocellular carcinogenesis. We hypothesized that gefitinib (G), an oral tyrosine kinase inhibitor of EGFR, should reduce recurrence rate and/or prolong recurrence free survival when given in adjuvant setting. Methods: We designed a multicenter pilot study with a plan to enroll 40 HCC patients with complete resection and or with positive resection margin or residual disease < 0.5 cm (microscopic disease). Treatment consisted of G 250 mg orally daily for 6 months starting within 6 weeks of surgery. Follow-up included serum alpha-fetoprotein levels and imaging studies every 3 months for the first 2 years, every 6 months for years 3-5 and yearly thereafter. Main endpoints were recurrence-free survival, toxicity and correlative genetic studies. All statistical analyses were carried out on an intention-to-treat basis. The end point of recurrence free survival will be pre...

Recurrence-free survival results from a pilot study of adjuvant gefitinib in resected hepatocellular carcinoma (HCC).

RF3-A Impact of Treatment Subsidies and Cash Pay-Outs on Treatment Choices at the End of Life

e21684Background: Approximately 15% of patients have pleural effusion at the initial diagnosis of advanced lung cancer. The best treatment approach to prevent re-accumulation of symptomatic MPE aft...

Effectiveness of EGFR-tyrosine kinase inhibitors (TKI) versus EGFR-TKIs plus talc pleurodesis in preventing recurrence of malignant pleural effusion (MPE) in advanced lung adenocarcinoma.

Akhil Chopra

Papers

Nivolumab (Nivo) in Patients (Pts) With Advanced Hepatocellular Carcinoma (HCC): the CheckMate 040 Study

Recurrence-free survival results from a pilot study of adjuvant gefitinib in resected hepatocellular carcinoma (HCC).

RF3-A Impact of Treatment Subsidies and Cash Pay-Outs on Treatment Choices at the End of Life

Effectiveness of EGFR-tyrosine kinase inhibitors (TKI) versus EGFR-TKIs plus talc pleurodesis in preventing recurrence of malignant pleural effusion (MPE) in advanced lung adenocarcinoma.