From the Guidelines
The recommended staging and treatment options for hepatocellular carcinoma (HCC) depend on tumor extent, liver function, and patient performance status, with the Barcelona Clinic Liver Cancer (BCLC) staging system commonly used to guide management, as supported by the most recent study in 2022 1.
Staging and Treatment Options
The BCLC staging system is widely used and encompasses all HCC patients, identifying those who may benefit from curative therapies, palliative treatments, or best supportive care.
- For very early-stage HCC (single tumor <2cm), surgical resection or radiofrequency ablation is preferred.
- Early-stage disease (single tumor or up to 3 nodules <3cm) may be treated with liver transplantation, surgical resection, or ablation.
- Intermediate-stage HCC (multinodular tumors without vascular invasion) is typically managed with transarterial chemoembolization (TACE).
- Advanced HCC with vascular invasion or extrahepatic spread requires systemic therapy, with first-line options including sorafenib or lenvatinib, as recommended by recent guidelines 1.
Treatment Selection
Treatment selection should consider liver function (Child-Pugh score), performance status (ECOG), comorbidities, and patient preferences.
- The Child-Pugh score is used to assess liver function, with grade C patients typically receiving best supportive care.
- The ECOG performance status is used to assess patient performance, with those having poor performance status receiving best supportive care.
- Comorbidities and patient preferences should also be considered when selecting treatment options.
Surveillance and Follow-up
Regular surveillance with imaging and alpha-fetoprotein testing every 3-6 months is essential for patients with cirrhosis to detect HCC at earlier, more treatable stages, as recommended by recent studies 1.
- Imaging techniques such as contrast-enhanced MRI or helical CT should be used to evaluate tumor extent.
- Alpha-fetoprotein testing should be used to monitor for tumor recurrence or progression.
From the FDA Drug Label
- 3 Hepatocellular Carcinoma LENVIMA is indicated for the first-line treatment of patients with unresectable hepatocellular carcinoma (HCC).
- 5 Recommended Dosage for Hepatocellular Carcinoma (HCC) The recommended dosage of LENVIMA is based on actual body weight: 12 mg for patients greater than or equal to 60 kg or 8 mg for patients less than 60 kg.
The recommended treatment option for hepatocellular carcinoma (HCC) is lenvatinib, with a dosage based on the patient's actual body weight.
- For patients weighing 60 kg or more, the recommended dosage is 12 mg once daily.
- For patients weighing less than 60 kg, the recommended dosage is 8 mg once daily. However, the FDA drug label does not provide information on staging for hepatocellular carcinoma (HCC) 2, 2, 2.
From the Research
Hepatocellular Carcinoma Staging
The staging of hepatocellular carcinoma (HCC) is crucial for guiding prognostication, management, and research purposes 3. There are several staging systems for HCC, including:
- Okuda staging system
- CLIP (Cancer of the Liver Italian Program) score
- MESIAH (Model to Estimate Survival In Ambulatory HCC patients) score
- ITA.LI.CA (Italian Liver Cancer) score
- BCLC (Barcelona Clinic Liver Cancer) staging
- HKLC (Hong Kong Liver Cancer) staging
- Alberta algorithm
Recommended Staging System
The BCLC staging system is the most validated and reliable system for prognostication 3, 4, 5. It incorporates tumor status, liver function, and patient performance to stage patients with newly diagnosed HCC. The BCLC staging system is widely used and links staging with treatment options.
Diagnosis and Staging
Diagnosis of HCC is often made on the basis of imaging features alone, without histologic confirmation 5. The American Association for the Study of Liver Diseases (AASLD) advocates the use of the BCLC staging system, which combines validated imaging and clinical predictors of survival to determine stage. Imaging modalities such as ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography are used in evaluating patients with chronic liver disease and suspected HCC 6, 7.
Treatment Options
Treatment options for HCC depend on the stage of the disease. The BCLC staging system helps determine suitable treatment options, including: