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The Future of Treatment in Hepatocellular Carcinoma

Insights From: Josep Llovet, MD, Mount Sinai School of Medicine; Riccardo Lencioni, MD, University of Miami Miller School of Medicine
Published: Wednesday, Feb 21, 2018



Transcript: 

Josep Llovet, MD: I think that the most promising trials currently in HCC are those that are trying to combine TKIs with checkpoint inhibitors. These will bring a lot of hope to patients, I would say, because with checkpoint inhibitors, we are targeting a proportion of patients; let’s say 40% to 50% of the patients. But all the other patients do not benefit from checkpoint inhibitors directly. This is because there are some mechanisms of silencing the tumor, where the tumor disappears from the immune system. We’re trying to rescue that with TKIs, and this will be the most important advancement, in my opinion, during the next year.

Riccardo Lencioni, MD: I think this is a very exciting time in HCC research. We now have 5 drugs that have been shown to have significant and meaningful effect on patients with advanced-stage HCC. We do have a number of locoregional therapies that are available. So, a very important area for research would be to investigate the potential of synergistic effect between locoregional interventional therapies and novel systemically active drugs.

Josep Llovet, MD: Another strategy that also emerged in non–small cell lung cancer with checkpoint inhibitors is to try to identify those patients who respond to these checkpoint inhibitors based on biomarkers. They use the immunostaining for PD-1 and PD-L1 as companion diagnostics for pembrolizumab used in non–small cell lung cancer. In HCC, we know that PD-1 or PD-L1 do not predict response to nivolumab. Now we are trying to test immune signatures that reflect the immune class and are trying to figure out if these immune signatures are the ones recognizing 30% of the patients who may be responding to nivolumab. This will be another advancement for the management of the patients.

Transcript Edited for Clarity 
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Transcript: 

Josep Llovet, MD: I think that the most promising trials currently in HCC are those that are trying to combine TKIs with checkpoint inhibitors. These will bring a lot of hope to patients, I would say, because with checkpoint inhibitors, we are targeting a proportion of patients; let’s say 40% to 50% of the patients. But all the other patients do not benefit from checkpoint inhibitors directly. This is because there are some mechanisms of silencing the tumor, where the tumor disappears from the immune system. We’re trying to rescue that with TKIs, and this will be the most important advancement, in my opinion, during the next year.

Riccardo Lencioni, MD: I think this is a very exciting time in HCC research. We now have 5 drugs that have been shown to have significant and meaningful effect on patients with advanced-stage HCC. We do have a number of locoregional therapies that are available. So, a very important area for research would be to investigate the potential of synergistic effect between locoregional interventional therapies and novel systemically active drugs.

Josep Llovet, MD: Another strategy that also emerged in non–small cell lung cancer with checkpoint inhibitors is to try to identify those patients who respond to these checkpoint inhibitors based on biomarkers. They use the immunostaining for PD-1 and PD-L1 as companion diagnostics for pembrolizumab used in non–small cell lung cancer. In HCC, we know that PD-1 or PD-L1 do not predict response to nivolumab. Now we are trying to test immune signatures that reflect the immune class and are trying to figure out if these immune signatures are the ones recognizing 30% of the patients who may be responding to nivolumab. This will be another advancement for the management of the patients.

Transcript Edited for Clarity 
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Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: New Directions in Advanced Cutaneous Squamous Cell Carcinoma: Emerging Evidence of ImmunotherapyAug 13, 20191.5
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