Page 89 - ebook HCC

86 PROGRAMME AND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 87
FEBRUARY 13 - 16, 2014

TODAY S MAJOR CHALLENGES IN MANAGING A NOTES
PATIENT WITH HEPATOCELLULAR CARCINOMA

Jordi Bruix 1
1 BCLC group. Liver Unit., Hospital Clínic. University of Barcelona, IDIBAPS.
CIBEREHD., Barcelona, Spain

Corresponding author’s e-mail: JBRUIX@clinic.ub.es

The diagnosis and treatment of patients with hepatocellular carcinoma has significantly
improved in the last two decades. Joint efforts by experts from different fields and
geographical origin have taken advantage of imaging technologies and treatment options
to elaborate a structured set of definitions to be used for the management of these
patients. This knowledge according to robust scientific evidence has been exposed in
BASIC SPEAKERS ABSTRACTS so that current clinical management of HCC patients is shared by practicing physicians BASIC SPEAKERS ABSTRACTS
clinical practice guidelines developed by several scientific associations and consortia,
and investigators. This allows further research to build on top of this clinical ground.
The current challenges affect from molecular profiling to diagnosis, prognosis prediction
and treatment. It is expected that the novel “omics” technologies will ultimately lead to a
molecular classification that is linked to treatment decision. However, biopsy sampling
has to face the heterogeneous nature of the tumor within the nodule, across nodules and
also, along its evolution. Hence, major effort should be place in the fruits of the so-called
“liquid biopsy” from peripheral blood. Indeed, this peripheral blood research may also
prime an earlier diagnosis or the recognition of the disease even prior to overt malignant
transformation. Until then, imaging techniques will be instrumental to improve the current
detection rate as well as the diagnostic confirmation capacity. Improved performance
and applicability of screening ultrasound are needed to reach an optimal effectiveness
of surveillance. Imaging techniques will gain accuracy for staging and molecular imaging
may become instrumental for diagnosis and prognostic prediction.The better knowledge
of molecular pathobiology and improved capacity to predict and influence tumor evolution
should change the current selection of the first line treatment approach that is mostly
based in rough assessment of tumor size and number. Criteria for liver transplantation
and surgery may be modified by such information that will include the assessment of the
risk of recurrence and the potential to reduce/eliminate it by molecular targeted agents.
Locoregional approaches based in physical damage may benefit from combination with
systemic agents or even be slowly replaced by biology-based treatments acting selectively
against tumor cells or the surrounding stromal population. Sorafenib has been the first
agent to show that tumor progression may be halted with a significant survival increase,
but there is need for major improvement to finally transform cancer into a chronic condition.
As known, generous combination of laboratory research with clinical research with critical
insight from all sides is the sole way to advance in all these fronts, while not forgetting that
the optimal approach would be to be able to prevent HCC development.