Ghassan Abou-Alfa, MD
While the hepatocellular carcinoma (HCC) field shifted in 2018 with the addition of newly available treatment options, more pivotal research is on the way, said Ghassan K. Abou-Alfa, MD.
, Abou-Alfa, a medical oncologist at Memorial Sloan Kettering Cancer Center, discussed the rapidly evolving treatment options in HCC and other developments in GI cancers.
OncLive: What have been the biggest advancements made in the field of HCC?
: It has been a great year with regard to many malignancies. Specifically, in the hepatobiliary domain, we have seen many positive changes. We are going to continue hearing a lot about the advances [being made] in HCC.
Other than TKIs, there has been great interest in exploring the role of checkpoint inhibitors. As I mentioned, nivolumab is the first one so far with a conditional approval. We are all eager to hear the results of the CheckMate-459 trial; this is of nivolumab versus sorafenib. This will help guide us for what is coming in the first-line setting. Will it be TKIs or checkpoint inhibitors?
What is the treatment approach for patients with biliary cancers?
The second biggest discussion [in the space] has focused on biliary cancers and the adjuvant approach. Is it chemotherapy alone, as we gather data from the BILCAP study with capecitabine? Or, is it going to be a regimen of chemotherapy plus radiation? It will be nice to see the 2 different approaches.
Are there other recent data in the space that you are excited about?
Something else we are seeing some data with is fibrolamellar carcinoma; this is a very rare cancer that, unfortunately, affects people in their 20s and 30s. Sadly, it still does not have a standard of care. One of our fellows [at Memorial Sloan Kettering Cancer Center recently] presented a very educational case in terms of this disease. He gave a prelude to some of the ongoing clinical trials in this space. There is, specifically, a study evaluating the use of neratinib (Nerlynx) for these patients. We can at least be excited that there is ongoing [research] for these patients.
- Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018;391(10126):1163-1173. doi:10.1016/S0140-6736(18)30207-1.
- Zhu AX, Finn RS, Edeline J, et al. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial [published online June 1, 2018]. Lancet Oncol. doi: 10.1016/S1470-2045(18)30351-6.
- Abou-Alfa GK, Meyer T, Cheng A-L, et al. Cabozantinib (C) versus placebo (P) in patients (pts) with advanced hepatocellular carcinoma (HCC) who have received prior sorafenib: Results from the randomized phase III CELESTIAL trial. J Clin Oncol. 2018;36(suppl 4S; abstr 208).
- Zhu A, Kang YK, Yen CJ, et al. REACH-2: a randomized, double-blind, placebo-controlled phase 3 study of ramucirumab versus placebo as second-line treatment in patients with advanced hepatocellular carcinoma (HCC) and elevated baseline alpha-fetoprotein (AFP) following first-line sorafenib. REACH-2 investigators. J Clin Oncol. 2018;36(suppl; abstr 4003). ascopubs.org/doi/abs/10.1200/JCO.2018.36.15_suppl.4003.
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