Locoregional Therapies and High Lung Shunts: An HCC Highlight With Dr. Ripal Gandhi

In this brief highlight from IO Learning’s interview with Dr. Ripal Gandhi, MD, FSVM at Miami Cardiac and Vascular Institute, we discuss locoregional therapies for the treatment of HCC as well as high lung shunt management for HCC patients.

 

In this brief highlight from IO Learning’s interview with Dr. Ripal Gandhi, MD, FSVM at Miami Cardiac and Vascular Institute, we discuss locoregional therapies for the treatment of HCC as well as high lung shunt management for HCC patients. Read the interview below: 
 

IO Learning:

What points of discussion do you think are most interesting regarding advances in locoregional therapies for the treatment of HCC?

Dr. Ripal Gandhi:

I think the most important advances here are really going to be combining locoregional therapies with systemic therapies, specifically immunotherapy. I think we have the potential to have much better outcomes in doing this, although we have to conduct the proper clinical trials. For example, there was a trial called the LAUNCH trial, which showed the addition of chemoembolization—specifically to advanced stage patients—improved overall survival. But, I think that's just the beginning and we really have to investigate this area much further.

IO Learning:

Can you give an overview of how you manage high lung shunts?

Dr. Ripal Gandhi:

The management of high lung shunts is really a whole talk, but I can give you the different techniques that we utilize. It's typically in hepatocellular carcinoma (HCC) patients who have very large diffuse infiltrative disease, often with vascular invasion. Some of the methods include utilization of TACE or bland embolization. External beam radiation therapy has been utilized as well. Hepatic venous occlusion balloons is another technique. Embolization of portosystemic shunts also works. And finally, systemic therapy, and the utilization of things such as NEXAVAR (sorafenib) in the past. 

Although, I think some of the newer therapies such as Atezolizumab plus Bevacizumab, Durvalumab, Tremelimumab, and other kinase inhibitors might have even a better ability to decrease the shunt. And finally, a low dose Y90, although that has not been studied as well.