An Update on Immunotherapy in Liver Cancer - Episode 2

Hepatocellular Carcinoma: Immunotherapy After Sorafenib


Ghassan K. Abou-Alfa, MD: Sorafenib, as we all know, has shown true evidence of improvement in survival, but there is not necessarily a connection with any response to the therapy. Actually, the response to sorafenib is almost next to nothing. Nonetheless, the tumors can stabilize, patients can definitely benefit from the therapy, and we see improvement in survival.

With TKIs, some of them might show some improvement in regard to the response, and I would expect something in the up-to-5% range. However, checkpoint inhibitors, or immunotherapy, are bringing a whole different game to the field. If anything, now with the checkpoint inhibitors we’re seeing great responses. If anything, the understanding that we have so far from the data that have been reported is that the expected response to a checkpoint inhibitor, like an anti-PD-1, is close to about 20%. There is no doubt that in our community practices, and anywhere that we would see patients with HCC looking for a response with their checkpoint inhibitors, that is by all means something to aspire to and expect.

Immunotherapy is a treatment that will drive itself to a blockade of certain inhibitors of the immune system, which are what you call checkpoints, including PD-1, PD-L1, and CTLA-4. If anything, the understanding is that in the PD-1 setting, our foot on the brake will be removed and the immune system can act against the cancer. We thought that if there is a certain expression of PD-1, then the drug will work better. Interestingly, that connectivity is not necessarily there 100% in regard to liver cancer. In other words, I would not necessarily advise for a patient to receive checkpoint inhibitors only if they have expression of PD-1 in their tumor. Actually, they might still benefit regardless of the expression.

Transcript Edited for Clarity

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