What treatments are there for fibrolamellar?*

  1. Surgery –  to “debulk” the tumor and remove any disease visible to the eye of the surgeon. The only treatments with a track record of curing patients are resection or transplant (if possible.)
  2. Chemotherapy – In certain patients chemo can provide partial or complete responses. The only chemo with published results is the combination of 5fu+interferon. In light of the dearth of evidence supporting the use of any particular treatment doctors will often try a wide variety of treatments on a case by case basis.
  3. Local non-surgical treatment:
    •  cryoablation(freezing the tumor)
    •  radio frequency ablation( killing the tumor with heat)
    •  external beam radiation
    •  embolization-with or w/o chemo(for liver only, blood flow to one side of the liver is blocked and sometimes chemo is infused directly into the liver)
    •  nanoknife (irreversible electroporation), this involves the killing of tumors by making holes in them through the application of electrical current
    •  percutaneous hepatic perfusion- the liver’s blood supply is temporarily disconnected from the body’s circulation and chemo is circulated throughout the liver for a short time.
    •  y90 microspheres- small radioactive beads are introduced into the blood vessels that feed the tumor and irradiate them from within
  4. Immunotherapy:
    • Checkpoint inhibitors – PD1 inhibitors such as Keytruda (pembrolizumab) or Opdiva(nivolumab) may be beneficial alone or in combination with other checkpoint inhibitors, or local treatment such as radiation or cryoablation
    • CTLA4 inhibitors such as Yervoy (ipilimumab)

The above list may not be complete.

Click here for a very complete overview of treatments for fibrolamellar written by one of our medical advisors, Dr. Choti, on medscape.com 

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