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Abstract Details
Systemic Therapies in Advanced Hepatocellular Carcinoma: How Do Older Patients Fare?
Zainul Abedin Kapacee1, Mairéad G McNamara2, Nicola de Liguori Carino3, Angela Lamarca1, Juan W Valle2, Richard A Hubner4
Eur J Surg Oncol. 2020 Mar 27;S0748-7983(20)30369-3. doi: 10.1016/j.ejso.2020.03.210.Online ahead of print.
Author information
1Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom.
2Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester/Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom.
3Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom.
4Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom. Electronic address: Richard.Hubner@christie.nhs.uk.
Abstract
Advanced hepatocellular cancer (HCC) is the fourth leading cause of cancer-related death globally and is most common in elderly patients with a peak incidence in the UK at ages 85-89 years. In addition to the well-established risk factors of alcohol and viral hepatitis B and C, rising obesity and associated non-alcoholic fatty liver disease is projected to contribute to increased incidence of advanced HCC in elderly patients. The management of advanced HCC is changing rapidly; for over a decade the multi-kinase inhibitor sorafenib has been the only treatment option that offered a proven survival advantage, but in the last 4 years other treatment options have emerged including other kinase inhibitors, and monoclonal antibodies targeting angiogenesis and immune checkpoint inhibitors. Recent clinical trials have recruited older patients with no maximum age exclusion criteria, and age has not been found to be predictive for treatment effect in subgroup analyses. Chronological age is an unreliable measure of fitness for treatment and frailty may be a more apt descriptor, but the lack of a unified assessment tool has limited its use in current practice. Development of unified frailty assessments and prospective large-scale studies of novel systemic therapies where age and frailty are evaluated would be informative.