Ahmed O. Kaseb, MD, discusses the progression of therapy options for patients with hepatocellular carcinoma.
Ahmed O. Kaseb, MD, a professor in the Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, discusses the progression of therapeutic options for patients with hepatocellular carcinoma (HCC).
Sorafenib (Nexavar) and lenvatinib (Lenvima) will still have a role in the treatment of patients with HCC despite the approval of atezolizumab (Tecentriq) plus bevacizumab (Avastin). Results from a meta-analysis that was published in the Journal of Clinical Oncology in 2017 examined all phase III studies with sorafenib and showed a trend toward improved survival and outcomes in patients with hepatitis C—related HCC. If a patient with a history of hepatitis C receives frontline atezolizumab plus bevacizumab and progresses, they can then receive sorafenib because of its potential increased efficacy in those with hepatitis C, explains Kaseb.
If a patient has a history of hepatitis B, then lenvatinib, cabozantinib (Cabometyx), or another second-line agent may be effective, as lenvatinib has been shown to have benefit in those with hepatitis B, explains Kaseb. Choosing the appropriate drug to start with will depend largely on the patient’s risk factors, adds Kaseb.
Down the line, more studies will be launched, and more approved doublets will emerge in HCC, predicts Kaseb. For example, one study is evaluating the use of pembrolizumab (Keytruda) plus lenvatinib. Another study is evaluating atezolizumab plus cabozantinib; yet another is examining durvalumab (Imfinzi) and tremelimumab. Many ongoing studies are expected to read out by the end of next year, and those data will hopefully lead to more available options for patients with HCC, concludes Kaseb.