An Update on Immunotherapy in Liver Cancer - Episode 1
Ghassan K. Abou-Alfa, MD: Liver cancer is an extremely common cancer worldwide. If anything, we’ve really been struggling very hard to try to get new therapies for liver cancer. Between 2017 and 2018, we are seeing an incredible amount of new information that’s really providing us enlightenment for new potential therapies for patients. Important, of course, is immunotherapy or what you call “checkpoint inhibitors.” The simple way of thinking about it is as if the cancer cells are putting their foot on the brake for our immune system, so it can’t really fight our cancer. We’re simply taking their foot off and letting the immune system drive its activity against the cancer, per se. There have been a lot of improvements in that regard and there’s already a drug approved for that situation. We are expecting more data to come in that regard.
Liver cancer, or hepatocellular carcinoma, as we all know, has been rather a challenge in regard to treatment when it comes to systemic therapy. And since 2007 when we heard about sorafenib, there has been no activity despite all the great efforts in regard to other treatments that can be used. Between 2017 and 2018, we are hearing about a lot of positive data as well as the approval of new therapies.
I would say that other than the multiple tyrosine kinase inhibitors, or TKIs, there has been a major improvement in regard to the use of the checkpoint inhibitors, or immunotherapy. If anything, the effort that has been made on multiple layers has led to nivolumab being approved by the FDA in 2017. This was based on a conditional approval based on phase II data, and we expect that further data will be coming out from the different studies that are ongoing.
As we know, immunotherapy and checkpoint inhibitors can, by definition, work in any cancer. But with no doubt, some of those cancers are more prone to get a response compared to others. Liver cancer, because of its inflamed nature to begin with, appears to drive a very receptive environment for treatment with checkpoint inhibitors. The early data have shown—in regard to preclinical work as well as phase I and phase II studies—clear evidence of response to checkpoint inhibitors, and there is no doubt that this is really where the future will be coming.
Of note, we have thought that checkpoint inhibitors may be driven to work or not work based on the expression of certain receptors like PD-1 or PD-L1 or what have we, but it appears that’s not necessarily driving the case in liver cancer.
Transcript Edited for Clarity
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