Unmet Needs in Systemic Therapy for Liver Cancer



Arndt Vogel, MD: In the past year, there have been a lot of negative trials in HCC, both in first-line and also in second-line. The first positive trial was with sorafenib, which was published in 2008. And a lot of investigators thought that treatment with sorafenib could clearly be improved with other tyrosine kinase inhibitors. And sorafenib was always considered as a low-hanging fruit, as well as treatment in second-line where we only have best supportive care. So, it was really a surprise that all these drugs that have been tested in the last 10 years have failed both in first-line and in second-line. And there really are numerous phase III trials and also a lot of phase II trials that were not able to be either better than sorafenib or compared with best supportive care. The past 10 years have been really extremely disappointing in respect to systemic therapies. Luckily, now there is really a change and we have new drugs available. One of them would be regorafenib, and today we also have heard about lenvatinib. And I think there are more interesting studies to come with the immunotherapies.

Oliver Waidmann, MD: From former times to several years ago, we know that about 20% to 30% of patients were started on local ablative treatment or locoregional treatment, finally receiving systemic treatment. So, we lost a lot of patients. Of course, probably it was also the fact that we didn’t have that many treatment options for systemic treatment. We just had sorafenib, or even in former times, we just had doxorubicin, which was not really effective in systemic treatment. That’s why I think the rates would increase. We have new drugs that we can apply to the patients. We have several lines of systemic treatment, and we have the evidence that it’s improving survival. So, I think the rates will increase. I think it will definitely be more than 20% to 30% in the future.

Arndt Vogel, MD: The unmet needs for systemic therapy in HCC are clearly that we need more drugs that we can use in our patients. So far, we have just been able to use 1 drug, sorafenib, for all patients. We do not have any biomarkers that would identify patients who would benefit the most from the treatment, and we do not have any really effective second-line treatment, at least for the past 10 years. Now we have 2 positive trials that have been reported in HCC, and with that, we have now more options and we can decide which drug is the best drug for our patient. And we have to decide in which sequence we should give these drugs.

Transcript Edited for Clarity Brought to you in part by Eisai

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