Gazala N. Khan, MD, gastrointestinal medical oncologist, Henry Ford Health System, discusses sequencing strategies in advanced hepatocellular carcinoma.
Gazala N. Khan, MD, medical oncologist, Henry Ford Health System, discusses sequencing strategies in advanced hepatocellular carcinoma (HCC).
Given the recent advances in this disease that have led to several FDA-approved agents in the frontline and second-line settings, sequencing is going to be a challenge, Khan says. However, data from the REFLECT study suggest that lenvatinib (Lenvima) is the preferred frontline agent after showing superior response rates and time to progression compared with sorafenib (Nexavar).
In terms of second-line therapy, there are many reasonable options like cabozantinib (Cabometyx) and ramucirumab (Cyramza). Nivolumab (Opdivo) may also be a suitable second-line option, contingent on more mature data. Until more data define the optimal sequence of these drugs, Khan says it should be decided by patient characteristics and preference.