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Experts Remain Hopeful About Immunotherapy in HCC

Caroline Seymour
Published: Tuesday, Mar 19, 2019

Richard D. Kim, MD

Richard D. Kim, MD
Although pembrolizumab (Keytruda) failed to demonstrate a statistically significant improvement in progression-free survival (PFS) and overall survival (OS) in patients with previously treated advanced hepatocellular carcinoma (HCC), the treatment armamentarium remains strong, with the use of TKIs, monoclonal antibodies, and another checkpoint inhibitor, said Richard Kim, MD.

State of the Science Summit™ on Gastrointestinal Malignancies, Kim, an assistant professor of oncology at University of South Florida College of Medicine and a medical oncologist in the Department of Gastrointestinal Oncology at Moffitt Cancer Center, discussed the therapeutic landscape of advanced HCC in light of recent findings and highlighted anticipated research in the field.

OncLive: How has the field of HCC evolved in recent years?

Kim: There has been a tremendous evolution in the treatment of HCC. Since 2007, the only drug that was FDA approved for the treatment of patients with advanced HCC was sorafenib. Recently, there have been many advances in the treatment of patients with HCC, including TKIs along with immunotherapy.

What targeted therapies have been introduced into the field?

Until last year, sorafenib was the only drug that was approved in the first-line setting. Now, we have another TKI called lenvatinib; it's a dirty TKI that blocks the VEGF/EGFR/FGFR pathways. That was approved by the FDA last year based on findings from the REFLECT trial, which was a phase III noninferiority trial against sorafenib. The trial showed that lenvatinib was noninferior to sorafenib. If you look at the secondary endpoints of time to progression, PFS, and response rate, it seems like lenvatinib was superior in those regards. However, the OS was very similar between treatments. Sorafenib tends to have more hand–foot skin reaction. Lenvatinib tends to have a higher rate of hypertension. There are subtle differences between the 2 drugs, but now we have another option for patients in the frontline setting.
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