Samuel Kim - Department of Surgical Oncology
If I learned one thing in life it was that traditionally, hepatocellular carcinoma (HCC) has had very poor outcomes without a clear medicinal treatment course after resection. HCC is usually treated with surgical resection or ablation therapy.
After reading “Molecular predictors of prevention of recurrence in HCC with sorafenib as adjuvant treatment and prognostic factors in the phase 3 STORM trial,” by Pinyol et al., I discovered that there is a possibly efficacious drug known as sorafenib that decreases recurrence post-resection of HCC. However, sorafenib did not improve recurrence rates for HCC after resection compared to placebo groups (or patients with traditional courses of therapy) in the STORM drug trials. As a result, the article elaborated on recent drug trials by investigating prognostic markers (or tests to see what chemical markers were correlated with improved outcomes in patients) to improve the efficacy of the drug.
I discovered that pERK-negativity (less pERK activation) in hepatocytes was related to better responses to sorafenib contributing to decreased recurrence. ERK is a downstream kinase related to the MAPK pathway which is often mutated in cancer cells, and pERK, as a molecular marker, measures the activation (phosphorylation) of this carcinogenic pathway.
I realized that, due to a small cohort size of 188 samples, more investigation is warranted to confirm their claims and explore other markers.
Even so, the prospect of combining sorafenib use for future treatment of HCC and histological testing for individualized sequences of therapy for HCC is exciting. I plan to implement this thought pattern of using new testing methods to individualize therapy for patients in my future practice.
Do you believe individualized medicine is useful in oncology? Send us a message and we are happy to discuss this topic more with you!
References:
Pinyol R, Montal R, Bassaganyas L, et al. Molecular predictors of prevention of recurrence in HCC with sorafenib as adjuvant treatment and prognostic factors in the phase 3 STORM trial. Gut. 2019;68(6):1065-1075. doi:10.1136/gutjnl-2018-316408
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