On the HCC Treatment Horizon - Episode 4

Immunotherapy Approaches in Hepatocellular Carcinoma


Josep Llovet, MD: Immunotherapy has been a change-maker in the management of oncology. It is a natural revolution and has changed the management of several solid tumors. Now, nivolumab is the first checkpoint inhibitor thoroughly tested in HCC and has been approved by the FDA as second-line therapy based on a single-arm trial including 260 patients. It has also been tested head-to-head with sorafenib in the frontline setting. We will actually know the results of this very important study this year, and this might represent a breakthrough in the management of the disease if the study is positive.

There are 2 or 3 challenges regarding immunotherapy. The first is to understand the percentage of the population that we are providing benefit to. The objective response for nivolumab is 20%, but certainly, the scientific community understands that we’re providing benefit to more patients than those. It is true that in HCC, there is a percentage of patients—quantified around one-third of the patients—who have tumors with immune exclusion because there are no T cells whatsoever infiltrating their tumor. One of the challenges will be to combine immunotherapies with TKIs that are able to rescue these tumors that are silent with immunotherapy and, therefore, create benefit from checkpoint inhibitors. This is going to happen in the next year with the combinations of TKIs and checkpoint inhibitors, particularly nivolumab and pembrolizumab.

Transcript Edited for Clarity