Outlook and Expert Recommendations for Predictive, Preventive and Personalized Medicine and Hepatocellular Carcinoma

Abstract

In the concluding Chapter, the proposed benefits of an Information Technology System for Predictive, Preventive and Personalized Medicine (ITS-PM) will be presented in the form of expert recommendations and outlook for Predictive, Preventive and Personalized Medicine (PPPM) and hepatocellular carcinoma (HCC). To advance PPPM, the subject of HCC will be presented from a more integrated point of view, combining epidemiology, risk factors, infectious etiologies, pathology, microenvironment and biomarkers, screening and diagnostic technologies, and treatment modalities (single, combined, and/or sequential). It is hoped that by means of an ITS-PM for HCC, greater emphasis may be given to individual patient characteristics than is currently achievable. It is also hoped that through extensions to current screening, staging, and treatment algorithms that we can improve the understanding, prevention, and treatment of HCC. Through the development of an ITS-PM, it may be possible to provide and validate a new methodology for Evidence-Based Medicine utilizing model theory, i.e. Model-Based Medical Evidence (MBME). The information processed in the development of this book was used to reinforce and expand a well-established treatment algorithm, i.e. the Barcelona Clinic Liver Cancer (BCLC) staging system, and, to add extensions that include enhanced screening and greater specifics regarding treatment selections. Finally, new algorithms are presented that relate to alternatives in palliative treatments, down staging, and dealing with progression of disease. Treatments for HCC included in these algorithms include surgical resection, liver transplantation, percutaneous ablation, transarterial chemoembolization (TACE), local radiotherapy with Yttrium-90 microspheres, stereotactic body radiation therapy (SBRT), and systemic targeted therapy with the oral multikinase inhibitor, sorafenib.