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NCCN Trends™ Highlights: Utilization of Locoregional Therapies for Hepatocellular Carcinoma

By Sherry L. Ulrich, MBA, Market Insights Specialist, NCCN

Hepatocellular carcinoma (HCC), the most common type of cancer in the liver, gallbladder, and bile ducts, is usually diagnosed at an advanced stage and is the third leading cause of cancer-related deaths worldwide.1 Liver transplantation is an ideal potential curative therapy, but, with the limited number of donors, many patients’ HCC progresses due to the wait time, at times leaving them ineligible for transplant.2

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Hepatobiliary Cancers, Version 2.2015, recommends that all patients with HCC be evaluated for potential curative therapies (eg. resection, transplantation).  Patients that are not surgical candidates for potential curative therapies should consider locoregional therapy (eg. ablation).  These therapies can be utilized for patient management and/or to bridge patients for other curative therapies.3

In March, 2014, the National Comprehensive Cancer Network® (NCCN®) conducted an NCCN Trends™ survey about HCC and locoregional therapy.  At the time of the survey, 44% of respondents noted they are somewhat knowledgeable of treatment devices/procedures that are used as locoregional therapy, while 30% said they are very or extremely knowledgeable.

With regard to hepatocellular carcinoma (HCC) and metastatic colorectal cancer (mCRC), how knowledgeable are you of the treatment devices/procedures that are used as locoregional
therapy? (n=286)

***Only the HCC results are currently presented.

Clinicians were also asked which liver-directed therapies they recommend for patient management.  The most recommended therapy was conventional transarterial chemoembolization (80%), followed by radiofrequency ablation (76%).

Which of these liver-directed therapies do you recommend for patient management? (check all that apply) (n=275)

Although locoregional therapies play a key role in therapeutic management and may offer prolonged survival to a patient with HCC, they do have limitations, one of which is a high rate of tumor recurrence.4  The rate of recurrence depends on several factors, including but not limited to the stage of the tumor at the time of locoregional therapy, as well as any metachronous tumors that may develop independently from previous cancer.4 These therapies may offer prolonged survival, and ablation may be curative in some patients with small tumors.5

In summary, HCC is one of the leading causes of cancer-related deaths worldwide.  Although transplant or resection are potentially curative, most patients must rely on locoregional therapies, which may help to prolong survival.  In order to provide for a potentially better long-term outcome, clinical trials continue to investigate systemic and locoregional therapies, sometimes in combination, with a primary endpoint of recurrence-free survival.6,7 The long-term aim of these research efforts is to remove HCC as a leading cause of cancer death.

Additional Resources:

Patient Advocacy Summit: Value in Cancer Care – Patient Perspectives

While value is often an elusive concept, it is particularly so when applied to cancer care. Most simply, value is usually understood as the outcome when benefits exceed costs. The Institute of Medicine (IOM) defines value as “best care for lower cost”. But defining benefits and costs relative to cancer care is extremely difficult. Exactly which costs should be considered, and who determines what benefit is? In addition, the quality of the care must also be considered as a component of value.  Less expensive care does not contribute to value if the quality of care is insufficient.

Please join us on Tuesday, December 1 at The National Press Club when NCCN holds its 6th Annual Patient Advocacy Summit: Value in Cancer Care – Patient Perspectives. This event will provide a forum for discussion of challenges and obstacles that impact and hinder patient access to appropriate care, offer a chance for the oncology community to discuss cost and payment for medical interventions, and provide an opportunity to address how patients define value in cancer care.

For additional information, please visit: http://www.nccn.org/professionals/meetings/oncology_policy_program/patient_advocacy_patient_perspectives.aspx


NCCN Trends Surveys & Data

NCCN Trends is a survey-based analytics tool from NCCN that focuses on how clinicians in the United States and abroad deliver cancer care. NCCN Trends Surveys pose questions regarding topics including, but not limited to, patterns of care and awareness and utilization of various treatment modalities, as well as key topics impacting oncology stakeholders, such as how changes in the health care environment impact them and their patients.

Data is gathered through brief electronic surveys to more than 154,000 health care providers who access NCCN.org on a frequent basis and express interest in responding to NCCN Trends Surveys. These clinicians consist of practicing physicians in diverse practice settings, including academic/research cancer centers, community hospitals, and private practices. Survey participants also represent pharmacists, nurses, and other oncology stakeholders. In 2014, NCCN conducted 12 NCCN Trends Surveys, averaging more than 900 clinician respondents per survey.

NCCN TrendsSurveys and Data are independent of any NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) or other NCCN clinical recommendations.

To participate in future NCCN Trends™ surveys, please update your NCCN registration profile at https://www.nccn.org/store/Profile/Profile.aspx and select the option to receive NCCN Trends™ communications.

If you would like to sponsor an NCCN Trends survey in the future, please contact Sherry Ulrich at Ulrich@nccn.org.


1 www.cancer.gov/types/liver/patient/adult-liver-treatment-pdq#section/all. Accessed November 5, 2015.

2 Dawson LA. Overview: Where Does Radiation Therapy Fit in the Spectrum of Liver Cancer Local-Regional Therapies?  Semin Radiat Oncol. 2011;21:241-246.

3 National Comprehensive Cancer Network®, NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®); Hepatobiliary Cancers, Version 2.2015. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#hepatobiliary

4 Lencioni R. Loco-Regional Treatment of Hepatocellular Carcinoma. Hepatology. 2010;52(2):762-773.

5 Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology. 2004;127(5);S179-S188.

6 Huo YR, Eslick GD. Transcatheter Arterial Chemoembolization Plus Radiotherapy Compared With Chemoembolization Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. JAMA Oncol. 2015;1(6):756-765.

7 Chao Y, Chung YH, Han G, et al. The combination of transcatheter arterial chemoembolization and sorafenib is well tolerated and effective in Asian patients with hepatocellular carcinoma: final results of the START trial. Int J Cancer. 2015;136:1458-1467.