1) Medical oncologists may underestimate the resectability of liver metastases from colorectal cancer. 2) HIV infection does not adversely affect outcomes of liver transplantation for hepatocellular carcinoma compared to HIV-uninfected patients. 3) Early data shows promise for combining sorafenib with doxorubicin eluting bead transarterial chemoembolization for metastatic liver cancer.

1. what is new in Hepato
pancreato biliary
malignancy in 2014
DR DIPANJAN PANDA. MD DM
ASSOCIATE PROFESSOR OF ONCOLOGY
INSTITUTE OF LIVER & BILIARY SCIENCES

2. Hepatobiliary
Ca

3. Medical Oncologists Underestimate
Resectability of Liver Metastases
Choti MA, Green MR, Wong SL, et al: Medical oncologists’ assessment of resectability in patients with liver-limited metastatic colorectal cancer. Abstract AB2013-3.
Presented March 15, 2013.

4. HIV Infection Does Not Adversely Affect
Outcomes of Liver Transplantation for
Hepatocellular Carcinoma
 Liver transplantation for hepatocellular carcinoma is feasible for
HIV-infected patients, with no differences in post-transplant
survival or hepatocellular carcinoma recurrence rates compared
with liver transplantation for hepatocellular carcinoma in HIV-
uninfected patients
 All HIV-infected patients were given HAART until liver
transplantation, and antiviral therapy was discontinued only until
liver function stabilized.
Di Benedetto F, Tarantino G, Ercolani G, et al: Multicenter Italian experience in liver transplantation for hepatocellular carcinoma in HIV-infected
patients. Oncologist. May 10, 2013 (early release online).

5. Early Data Promising for Concurrent
Sorafenib Plus Embolization in Metastatic
Liver Cancer
Feng A, Reyes D, Kamel I, et al: Prospective phase II trial of sorafenib combined with doxorubicin eluting bead-transarterial chemoembolization for patients with
unresectable hepatocellular carcinoma: Efficacy analysis. Society of Interventional Radiology Annual Scientific Meeting. Abstract 134. Presented April 16, 2013.

6. Irinotecan Drug-Eluting Beads Improve
Outcomes in Colorectal Cancer Patients
With Liver Metastases
Martin RCG, Scoggins CR, Rilling WS, et al: Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients
with unresectable colorectal liver-limited metastasis. 2014 Gastrointestinal Cancers Symposium. Abstract 174. Presented January 17, 2014.

7. Duration Associated with Survival in
Advanced Hepatocellular Carcinoma
Treated with Sorafenib
 Aim: to clarify the correlation between stable disease (SD) periods and overall
survival (OS) in patients with hepatocellular carcinoma (HCC) treated with
sorafenib.
 Results:
 patients classified as having short stable disease had a median OS of 5.7
months and patients in the long stable disease had 20.8 months.
 Patients with a complete response or a partial response had a median
overall survival of 17.9 months.
 Conclusion: Achievement of long SD is one of the important goals for improving
survival in patients with HCC treated with sorafenib.
Dig Dis. 2014;32(6):705-10.

8. Radiogenomics of hepatocellular carcinoma:
Computed tomography biomarker to predict
microvascular invasion and clinical outcome.
 Results: Interobserver agreement for scoring RVI was good among 3 radiologists
(k=0.62, P<0.001). Diagnostic accuracy, sensitivity and specificity in the overall
cohort were 87%, 72% and 93%, respectively. Positive RVI score was associated with
lower overall survival than negative RVI score in the overall cohort. Positive RVI score
had lower recurrence-free survival at 3-years than negative RVI score (P<0.001; 62%
vs 85.4%).
 Conclusions: RVI is a noninvasive radiogenomic biomarker that accurately predicts
histologic MVI in HCC surgical candidates. Its presence is associated with early
disease recurrence and poor overall survival and may be useful for stratifying
patients less likely to derive a durable benefit from surgical treatment.
radiogenomic venous invasion (RVI)
J Clin Oncol 32:5s, 2014 (suppl; abstr 4089)

9. A phase III randomized, double-blind, placebo-controlled
study of sorafenib as adjuvant treatment in the prevention of
recurrence of hepatocellular carcinoma (HCC) after surgical
resection or local ablation (STORM)
 Conclusions: The primary endpoint of
the trial was not met. Adverse events
are consistent with the known sorafenib
safety profile and no new safety findings
were observed.
J Clin Oncol 32:5s, 2014 (suppl; abstr 4006^)

10. Linifanib Fails to Meet Overall Survival
Endpoint for Advanced Hepatocellular
Carcinoma
This open-label phase III trial evaluated efficacy and tolerability of linifanib versus sorafenib
in patients with advanced hepatocellular carcinoma (HCC) without prior systemic therapy.
Linifanib and sorafenib had similar OS in advanced HCC.
 Results:
 Median OS 9.1 months with linifanib and 9.8 months (HR = 1.046) with sorafenib. The
median TTP was found to be 5.4 months and 4.0 months (HR = 0.759; P = 0.001).
 In addition, objective response rates were 13.0% in the linifanib group and 6.9% in the
sorafenib group.
Conclusion
Linifanib and sorafenib had similar OS in advanced HCC. Predefined superiority and
noninferiority OS boundaries were not met for linifanib and the study failed to meet the
primary end point. TTP and ORR favored linifanib; safety results favored sorafenib.
JCO December 8, 2014 JCO.2013.54.3298

11. Gemcitabine Plus Sorafenib Not More
Effective Than Gemcitabine Alone for
Advanced Biliary Tract Cancer
 Result:
 there was no difference in overall survival between sorafenib and placebo (8.4
months vs 11.2 months, P = 0.775).
 no difference in median progression-free survival between the two group (3.0
months for sorafenib vs 4.9 months placebo, P = 0.859).
 The authors evaluated first–line gemcitabine plus sorafenib in a double–blind phase II
study. The addition of sorafenib to gemcitabine did not demonstrate improved efficacy
in advanced BTC patients.
European Journal of Cancer. Volume 50, Issue 18, December 2014, Pages 3125–3135

12. Vegetables, Not Fruit, Reduce Risk of
Hepatocellular Carcinoma
 The researchers found that for individuals with
high versus low intake of vegetables, the
summary relative risk for HCC was 0.72 (95 %
CI], 0.63 to 0.83).
 A 100 g/day daily increase in vegetable
intake correlated with a summary relative risk
of 0.92 for HCC (95 % CI, 0.88 to 0.95).
Yang Yang, et al. " Increased Intake of Vegetables, But Not Fruit, Reduces Risk for Hepatocellular Carcinoma: A Meta-analysis.
" Gastroenterology. gastro.2014.08.005. August 12, 2014.

13. Pancreatic Ca

14. Choice for Metastatic Pancreatic
Cancer: FOLFIRINOX or
Gemcitabine/Nab-Paclitaxel?
Berlin J, Hochster H: Divergent views: FOLFIRINOX vs. gemcitabine-Abraxane. 2014 Chemotherapy Foundation Symposium. Presented November 6, 2014.

15. Early Study Finds BRCA-Mutated
Pancreatic Cancer Responds to PARP
Inhibition Trio
The triplet combination [veliparib/cisplatin/gemcitabine] showed high activity in BRCA-related pancreatic adenocarcinoma.
—Eileen M. O’Reilly, MD

16. Early Study Reports Modified Vitamin D
Has Potential in Treatment for Pancreatic
Cancer
While the success of this drug in humans with pancreatic
cancer is still unclear, the findings in animal studies were
strong, raising hope that ongoing clinical trials will give
people with this terrible disease hope for a truly new type
of therapy.
—Ronald M. Evans, PhD
Sherman MH, Yu RT, Ding N, et al: Vitamin D receptor-mediated stromal reprogramming suppresses pancreatitis and enhanses pancreatic
cancer therapy. Cell 159:80-93, 2014.

17. Newer Approaches
In this era of biologics and the rise of immunotherapy, please discuss how
we currently approach this disease and which, if any, of the newer
approaches hold promise.
 Halozyme Therapeutics, which has developed a form of hyaluronidase that diminishes
the hyaluronan component of the stroma. In doing so, it reduces interstitial pressure and
may allow for more effective drug delivery.
 The other area of the microenvironment that is being tackled by our Stand Up To
Cancer team is immunomodulation (vaccine), which seeks to change the
immunoenvironment from a protumor to an antitumor environment.
 Chemotherapy agents that stabilize our patients allows this groundbreaking work to
move forward.