What systemic therapy would you offer to a pediatric patient with fibrolamellar hepatocellular carcinoma after an initial partial surgical resection?

My most commonly used systemic therapy for FLHCC is 5FU+IFN. Since FLHCC patient get excluded from HCC trails, there is no standard here.

There is no standard of care at this point, but most patients relapse and do poorly. At most, 20% are cured by surgery alone.

We at Rush (36 patients seen/ consulted on in the last 3 years with FLC) believe that fibrolamellar is a systemic disease, different from HCC in every way (genetics, histology, demographics) and therefore the HCC paradigms do not apply. We recommend systemic therapy with or without complete surgical resection. In addition, we believe that monotherapy (sorafenib, lenvatani...

There is no data for adjuvant therapy, thus close observation. Make sure tumor is evaluated for next generation sequencing.