Case Presentation:

Unresectable HCC
Indah Jamtani, Adianto Nugroho, Ro Saunar,
Aditomo Widarso, Taslim Poniman

Digestive Surgery - RSUP Fatmawati

fi

 Female, 60 y.o. - referred with abdominal pain

• Complained of upper abdominal discomfort and recurrent nausea

• No history of jaundice

• Denied any history of Hepatitis

• No history of cirrhosis

• History of ischemic stroke 4 months prior to present illness

 Female, 60 y.o. - referred with abdominal pain

• On physical examination:

• Hemodynamic was stable

• Cachexia

• No signs of jaundice

• No ascites

• No encephalopathy

• Unilateral weakness of the left side

• No palpable abdominal mass

 Female, 60 y.o. - referred with abdominal pain

• Child Pugh -A

• ECOG 1

 Suitability for Liver Resection

Hypertension
Hx of Stroke

Lung Metastasis

V. close to RHV—> resection along with RHV Allaire M, Goumard C, Lim C, Le Cleach A, Wagner M,
or Scatton O. New frontiers in liver resection for
hepatocellular carcinoma. JHEP Rep. 2020;2(4):100134.
Right hemihepatectomy






BCLC
Comparison of Guidelines

Allaire M, Goumard C, Lim C, Le Cleach A,

Wagner M, Scatton O. New frontiers in liver
resection for hepatocellular carcinoma.
JHEP Rep. 2020;2(4):100134.
Systemic Therapy

Tella SH, Kommalapati A, Mahipal A. Systemic therapy for advanced

hepatocellular carcinoma: targeted therapies. Chin Clin Oncol.
2021;10(1):10.
 • Non inferiority in OS when
compared to Sorafenib

• Statistically signi cant

clinically meaningful
improvement:

• Longer progression free

survival

• Greater objective response

rate
Tumor occupies > 50% of liver, main PV
invasion, BD invasion, poor liver function • Longer time to progression
—> excluded

fi

 Adverse Effect

Rimassa L, Danesi R, Pressiani T, Merle P. Management of adverse events associated with tyrosine kinase inhibitors: Improving outcomes for patients with hepatocellular carcinoma. Cancer Treat Rev. 2019;77:20-8.
 Adverse Effect

Lee J, Sung PS, Yang H, Lee SK, Nam HC, Yoo SH, et al. A Real-World Comparative Analysis of Lenvatinib and Sorafenib as a Salvage Therapy for Transarterial Treatments in Unresectable HCC. J Clin Med. 2020;9(12).
 Adverse Effect LEN

Wang DX, Yang X, Lin JZ, Bai Y, Long JY, Yang XB, et al. Ef cacy and safety of lenvatinib for Sasaki R, Fukushima M, Haraguchi M, Miuma S, Miyaaki H, Hidaka M, et al. Response to
patients with advanced hepatocellular carcinoma: A retrospective, real-world study conducted in Lenvatinib Is Associated with Optimal RelativeDose Intensity in Hepatocellular Carcinoma:
China. World J Gastroenterol. 2020;26(30):4465-78. Experience in Clinical Settings. Cancers (Basel). 2019;11(11).
fi
 • 73-year-old man with hypertension, obesity and
chronic atrial brillation received lenvatinib for 6
months without occurrence of cardiological
symptoms.

• Hypertension —> frequent adverse event

associated with lenvatinib.

• Use with caution in patients with cardiological

morbidity.

fi

THANK YOU