Amit G. Singal, MD
Hepatocellular carcinoma (HCC), a disease that accounts for approximately 90% of liver cancers worldwide, is often diagnosed in the advanced stage where treatment options have been limited, according to Amit G. Singal, MD. However, recent data have led to first- and second-line changes in the landscape.
at the 2018 State of the Science Summit™ on Gastrointestinal Cancers, Singal, associate professor and medical director of the Liver Tumor Program and clinical chief of Hepatology at UT Southwestern Medical Center, discussed the evolving armamentarium of treatment options for patients with HCC.
OncLive: What were the key points from your presentation?
: HCC is a cancer that is actually increasing in incidence and mortality in the United States. While we are making great progress in other cancers, the relevance and unmet need of HCC is rapidly increasing. Over the last decade, the HCC incidence has more than doubled, according to some data we have. One of the things we talked about is some of the interesting and exciting progress made in terms of treatment, particularly in advanced HCC management. This is important because most HCC cases occur in the advanced stage when they aren't eligible for curative therapies.
Furthermore, we finally have treatment options for second-line therapy. This means that if patients fail on lenvatinib or sorafenib, or if they progress, we have therapies we can use for those patients as well. We've had the RESORCE trial [with regorafenib] and the CheckMate-040 trial [with nivolumab]; both are positive and have FDA approval for these agents. Finally, I briefly touched on the CELESTIAL and REACH-2 studies [of cabozantinib (Cabometyx) and ramucirumab, respectively], which are positive trials in the second-line setting but are awaiting FDA approval.
With these recent advancements and FDA approvals, how important is sequencing?
This is going to be the biggest question. With all these tools in your toolbox, how do you decide which agents to use and when to switch? We've made progress in terms of making these agents available. The next step is how to determine the best agent to use first, and when we should switch. When do you declare that this patient is no longer responding?
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