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Alolyan A, Alshammari K, Arabi M, Alshehri A, Alsuhaibani H, Ibnshamsah F, Alsharm A, Mahrous M, Al Zanbagi A, Hassanain M, Bazarbashi S. Treatment Patterns and Recommendations for Improving the Management of Hepatocellular Carcinoma in Saudi Arabia. J Hepatocell Carcinoma 2024; 11:349-362. [PMID: 38385059 PMCID: PMC10879627 DOI: 10.2147/jhc.s442842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the sixth most common type of cancer in the world associated with high morbidity and mortality. Despite being a significant healthcare burden there is limited information on the unmet needs and current treatment practices for intermediate and advanced-stage HCC in Saudi Arabia. This article analyzes the gaps and provides expert consensus on the management strategies for unresectable HCC in Saudi Arabia. A pre-meeting online questionnaire, comprising 20 objective questions about the treatment landscape and diagnosis of HCC in Saudi Arabia, was distributed to experts in the field of HCC management. An advisory board meeting including a panel of 13 experts was held in September 2022 where the responses to the survey questionnaire were reviewed and discussed. The survey results and experts' discussion highlighted the growing incidence of liver cancer in Saudi Arabia. HCC comprised the majority of all liver cancer cases due to rising rates of chronic viral infections and lifestyle-related risk factors. Most physicians in Saudi Arabia follow the Barcelona Clinic Liver Cancer guidelines as a prognostic tool for the detection and staging of patients with HCC. Most of the patients with HCC in Saudi Arabia are diagnosed in the intermediate or advanced stages with poor prognoses and limited therapeutic options. Establishing evidence-based surveillance techniques, a multidisciplinary approach to diagnosis, and better accessibility of treatment options is vital for the management of HCC in Saudi Arabia.
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Affiliation(s)
- Ashwaq Alolyan
- Department of Medical Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Kanan Alshammari
- Department of Medical Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Arabi
- Department of Medical Oncology, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ahmed Alshehri
- Department of Oncology, King Khalid National Guard Hospital Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Hamad Alsuhaibani
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Fahad Ibnshamsah
- Department of Medical Oncology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mervat Mahrous
- Department of Oncology, Prince Sultan Military Medical City Hospital, Riyadh, Saudi Arabia
- Department of Medicine, Minia University of Egypt, Faculty of Medicine, Minia, Egypt
| | - Adnan Al Zanbagi
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Mazen Hassanain
- Department of Surgery, King Saudi University, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Waked I, Alsammany S, Tirmazy SH, Rasul K, Bani-Issa J, Abdel-Razek W, Omar A, Shafik A, Eid S, Abdelaal A, Hosni A, Esmat G. Multidisciplinary consensus recommendations for management of hepatocellular carcinoma in Middle East and North Africa region. Liver Int 2023; 43:2062-2077. [PMID: 37553777 DOI: 10.1111/liv.15685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/30/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023]
Abstract
Hepatocellular carcinoma (HCC) is a growing health concern projected to cross over a million cases worldwide by 2025. HCC presents a significant burden of disease in Middle East and North African (MENA) countries due to a high prevalence of risk factors such as hepatitis C and B infections and rising incidence of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. In August 2022, an advisory meeting consisting of experts from 5 MENA countries was convened in an attempt to provide consensus recommendations on HCC screening, early diagnosis, current treatment modalities and unmet medical needs in the region. Data were collected from a pre-meeting survey questionnaire and responses analysed and presented during the advisory meeting. This review summarizes the evidence discussed at the meeting and provides expert recommendations on the management of HCC. The 2022 update of Barcelona clinic liver cancer (BCLC) staging and treatment strategy and its implementation in the MENA region was extensively discussed. A key consensus of the expert panel was that multidisciplinary care is crucial to effective patient management that results in better clinical outcomes and overall survival of the patient. The panel recommended the use of predictive and early response biomarkers to guide clinicians in arriving at more effective therapeutic decisions. The experts also emphasized the role of robust screening/surveillance systems, population-based registries, effective referral pathways and standardization of guidelines to ensure the successful management of HCC in the region.
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Affiliation(s)
- Imam Waked
- Department of Medicine, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | - Sherif Alsammany
- Department of Medical Oncology, King Abdullah Medical City, Mecca, KSA
| | | | - Kakil Rasul
- Department of Medical Oncology, GI Unit, National Centre for Cancer Care and Research, Doha, Qatar
| | - Jafar Bani-Issa
- Department of Interventional Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Wael Abdel-Razek
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
| | - Ashraf Omar
- Department of Endemic Medicine and Hepato-Gastroentrology, Cairo University, Cairo, Egypt
| | - Amr Shafik
- Department of Clinical Oncology, Ain Shams University, Cairo, Egypt
| | - Salem Eid
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amr Abdelaal
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Ain Shams University, Cairo, Egypt
| | - Ahmed Hosni
- Department of Diagnostic and Interventional Radiology, Cairo University, Cairo, Egypt
| | - Gamal Esmat
- Department of Endemic Medicine and Hepato-Gastroentrology, Cairo University, Cairo, Egypt
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Albarrak J, Al-Shamsi H. Current Status of Management of Hepatocellular Carcinoma in The Gulf Region: Challenges and Recommendations. Cancers (Basel) 2023; 15:cancers15072001. [PMID: 37046662 PMCID: PMC10093592 DOI: 10.3390/cancers15072001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
The burden of hepatocellular carcinoma (HCC) is on the rise in the Gulf region, with most patients being diagnosed in the intermediate or advanced stages. Surgery is a treatment option for only a few, and the majority of patients receive either locoregional treatment (percutaneous ethanol injection, radiofrequency ablation, transarterial chemoembolization [TACE], radioembolization, radiotherapy, or transarterial radioembolization) or systemic therapy (for those ineligible for locoregional treatments or who do not benefit from TACE). The recent emergence of novel immunotherapies such as immune checkpoint inhibitors has begun to change the landscape of systemic HCC treatment in the Gulf. The combination of atezolizumab and bevacizumab is currently the preferred first-line therapy in patients not at risk of bleeding. Additionally, the HIMALAYA trial has demonstrated the superiority of the durvalumab plus tremelimumab combination (STRIDE regimen) therapy in efficacy and safety compared with sorafenib in patients with unresectable HCC. However, there is a lack of data on post-progression treatment after first-line therapy with either atezolizumab plus bevacizumab or durvalumab plus tremelimumab regimens, highlighting the need for better-designed studies for improved management of patients with unresectable HCC in the Gulf region.
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Affiliation(s)
- Jasem Albarrak
- Kuwait Cancer Control Center, Sabah Health Region, Kuwait City 8WF3+WR8, Kuwait;
| | - Humaid Al-Shamsi
- Burjeel Medical City- Burjeel Holding, Abu Dhabi 92510, United Arab Emirates
- College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
- Emirates Oncology Society, Dubai 22107, United Arab Emirates
- Correspondence:
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Development and validation of a simple and sensitive HPLC method for the determination of related substances in regorafenib tablets. ANAL SCI 2022; 38:591-599. [DOI: 10.1007/s44211-022-00068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/20/2021] [Indexed: 11/25/2022]
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