Mark Yarchoan, MD

Panelists discuss how immune-related adverse events typically occur between 3 and 15 weeks of treatment, with hepatitis being particularly concerning in patients with cirrhosis and requiring careful differentiation from disease progression or worsening cirrhosis, while high-dose steroids remain first-line treatment with consideration of steroid-sparing agents and potential rechallenge strategies for responding patients.

Panelists discuss how dual checkpoint inhibitors demonstrate significantly higher immune-related adverse event rates (nearly 30% grade 3-4) compared with atezolizumab-bevacizumab, but this increased toxicity is accompanied by meaningfully improved response rates, and the addition of anti-CTLA4 therapy roughly doubles response rates compared with anti-PD1 monotherapy in HCC.

Panelists discuss how the early survival curve crossing observed in the CheckMate 9DW trial likely reflects lenvatinib’s superior short-term disease control, while emphasizing that the real strength of nivolumab-ipilimumab lies in achieving durable complete responses and unprecedented long-term survival tails.

Panelists discuss how approximately half of patients have soft contraindications to specific regimens, with bevacizumab being avoided in patients with recent bleeding, uncontrolled hypertension, or cardiovascular events, while dual checkpoint inhibitors may be contraindicated in patients with poorly controlled autoimmune diseases.

Panelists discuss how all 3 approved immunotherapy doublets (atezolizumab-bevacizumab, durvalumab-tremelimumab, and nivolumab-ipilimumab) demonstrate superiority over tyrosine kinase inhibitor therapy, with each regimen offering distinct advantages—atezolizumab-bevacizumab for disease control, and dual checkpoint inhibitors for durable complete responses and long-term survival tails.

Panelists discuss how immunotherapy-based regimens have transformed HCC treatment by achieving median survivals of 16 to 24 months and enabling long-term survival with meaningful percentages of patients living 3 to 5 years, representing a dramatic improvement over the historical 2- to 3-month survival benefit seen with sorafenib.

Panelists discuss how patients with unresectable HCC present with dual challenges of managing both the cancer and underlying cirrhotic liver disease, emphasizing the complexity of applying clinical trial data from patients with Child-Pugh A status to the more heterogeneous Child-Pugh B population commonly seen in practice.

Closing out their discussion on the management of biliary tract cancers, experts share excitement for future evolutions in the treatment landscape.

Expert panelists provide comprehensive insight on novel targeted agents being investigated in advanced biliary tract cancers.

In the context of advanced biliary tract cancers, panelists reflect on the optimal sequencing of agents throughout multiple lines of therapy.

Expert perspectives on the toxicity profile of immunotherapy agents and how they can be managed in patients being treated for advanced biliary tract cancers.

Shared insight on efforts to identify patient subgroups that may benefit more from immunotherapy in the setting of advanced biliary tract cancers.

Centering their conversation on the TOPAZ-1 clinical trial, expert panelists review the use of IO + chemotherapy in advanced biliary tract cancers.

Focused discussion on chemotherapy treatment options commonplace in patients with advanced or metastatic biliary tract cancers.

Shifting their focus to the advanced disease setting, panelists provide a comprehensive overview on systemic treatment modalities used in biliary tract cancers.

Experts provide brief perspective on the use of adjuvant treatment approaches for patients with biliary tract cancers.

Before closing out their review of early-stage biliary tract cancer treatment options, panelists consider the role of transplant in the setting.

Centering discussion on early-stage biliary tract cancers, expert panelists consider the respective roles of surgery and embolization strategies in this setting.

Panelists share their perspectives on molecular testing guidelines for patients diagnosed with biliary tract cancers.

Comprehensive insight on staging biliary tract cancers followed by an overview of molecular testing and targetable clinicopathologic features.

Expert perspectives on the presentation of biliary tract cancers with specific insight to the challenges inherent in reaching a timely diagnosis.

Shared insight on the global incidence of biliary tract cancers and which risk factors most impact the likelihood of disease.

Opening their discussion on biliary tract cancers, a multidisciplinary panel of experts consider how specific subsets of these malignancies differ from one another.

Mark Yarchoan, MD, discusses the addition of durvalumab (Imfinzi) to gemcitabine and cisplatin in biliary tract cancer.

Closing out their discussion on hepatocellular carcinoma, expert panelists consider future directions in care.

Comprehensive insight on later-line immunotherapy and combination strategies available for patients with advanced hepatocellular carcinoma.

Expert panelists consider which therapy they would use following failure of atezolizumab + bevacizumab in advanced hepatocellular carcinoma.

Shared insight on which factors help to inform selection of second-line therapy for patients with advanced HCC following lenvatinib failure.

Centering discussion on a patient with advanced HCC, expert oncologists consider which agents they would use in the second line following lenvatinib failure.

Before closing out their discussion on frontline therapy for advanced HCC, expert panelists review other novel combinations under investigation.