Update on Systemic Therapy for Advanced Liver Cancer - Episode 9

Advanced HCC: Guiding Second-Line Therapy With AFP

Transcript: Nikolaos Pyrsopoulos, MD, PhD: I like your approach very much, and something that I see is that biomarkers are extremely important, and everybody is moving toward a new concept, which is the liquid biopsy nowadays. Unfortunately or fortunately, the diagnosis of hepatocellular carcinoma [HCC] during the last few years has been done by radiology findings. So there is a lack of tissue as well.

Andrew Zhu, MD, PhD: Absolutely, yes.

Nikolaos Pyrsopoulos, MD, PhD: Unfortunately, we cannot go back and check and identify more information, and we know that not all HCC is the same. There are different types of differentiation. We have the AFP producers versus the non-AFP producers. It is extremely important. And there is a medication actually that is very effective for AFP producers. Why don’t you tell us about the trial?

Andrew Zhu, MD, PhD: Yes, correct. I think definitely we have another agent, which is actually a monoclonal antibody against vascular endothelial growth factor receptor 2 [VEGFR2], ramucirumab. I think this is actually another unique agent in the treatment options for our patients. I think in contrast to all the TKIs that we discussed today, this is actually a unique molecule. It’s targeting specifically VEGFR2. And also safety-wise, I think it’s very distinct from other tyrosine kinase inhibitors [TKIs]. So the safety profile is notable only for hypertension, hyponatremia. I think in many ways the tolerability perhaps is more favorable compared with other TKIs.

But also based on the results from both REACH as well as REACH-2, I think it’s fair to say this is the first biomarker-selected trial where we were able to enrich the clinical efficacy in patients with hepatocellular carcinoma. We also know the high-AFP expressor is actually occurring in up to 40% to 50% of patients, so it’s actually a significant number of the patients with HCC. Also, this is a group of patients with poor prognosis. So I think having the availability of a unique molecule with a different safety profile definitely is a good advantage for our patients. I just don’t know whether we have any clinical experience using this drug at this point.

Nikolaos Pyrsopoulos, MD, PhD: What I would like to see is the combination of this medication tied up to something else.

Andrew Zhu, MD, PhD: Absolutely.

Nikolaos Pyrsopoulos, MD, PhD: Because definitely we have, as you mentioned, the biomarker, and we know this is very effective. How about if this is tied up with another category that will enhance response? And the potential will come at a higher level.

Transcript Edited for Clarity