Dr. El-Khoueiry on the Frontline Treatment Landscape in HCC

Anthony B. El-Khoueiry, MD, associate professor of clinical medicine, Keck School of Medicine, USC Norris Comprehensive Cancer Center, discusses the frontline treatment landscape of hepatocellular carcinoma (HCC).

For over a decade, sorafenib (Nexavar) was the only standard option to elicit an overall survival benefit compared with placebo in the frontline treatment of patients with advanced HCC, El-Khoueiry says.

Then, based on data from the phase 3 REFLECT trial, the multitargeted TKI lenvatinib (Lenvima) received regulatory approval, El-Khoueiry explains. Lenvatinib was found to be noninferior to sorafenib. However, per investigator review, lenvatinib demonstrated superior progression-free survival and response rates versus sorafenib.

Most recently, in May 2020, the frontline combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) received regulatory approval for the treatment of patients with metastatic or unresectable HCC. The approval was based on data from the IMbrave150 trial in which the combination demonstrated a 42% reduction in the risk of death compared with sorafenib, concludes El-Khoueiry.