Lewis R. Roberts, MB, ChB, PhD
While the liver cancer landscape is not as explosive with novel agents as some other solid tumor types, systemic and surgical advancements are still having an impact on the lives of patients.
In January 2017, a supplemental biologics license application for the multikinase inhibitor regorafenib (Stivarga) was granted priority review by the FDA as a second-line treatment for patients with unresectable hepatocellular carcinoma (HCC).
The application is based on findings from the phase III RESORCE trial, which showed that the median overall survival was 10.6 months with regorafenib plus best supportive care versus 7.8 months for placebo plus best supportive care. This translated into a 38% reduction in the risk of death (HR, 0.62; 95% CI, 0.50-0.78; P
“The main thing is that this is really a time of hope for patients with liver cancer,” says Lewis R. Roberts, MB, ChB, PhD. “For a long time, there was a sense of futility about liver cancer. Many patients presented with very advanced disease; there was not a whole lot that could be done for them. Many patients were only candidates for palliative care. I think that is changing.” During the 2017 OncLive®
State of the Science Summit on Gastrointestinal Malignancies, Roberts, a professor of Medicine at Mayo Clinic, spoke on the current state of HCC. In an interview, he discussed the recent advancements and emphasized the importance of a multidisciplinary approach.
OncLive: What did you discuss during this State of the Science Summit?
: I tried to remind people that, of all of the major cancers, liver cancer is the most deadly. People are most likely to die within 1 year of diagnosis for liver cancer than for most of the other major cancers.
The other important thing is that, in the United States, we are finding that liver cancer is increasing in its incidence, whereas for many other cancers, we’re actually seeing a decrease in numbers and deaths. We are actually seeing a rise in liver cancer cases; it is becoming a more important cancer here in the United States.
In terms of treatment of patients with liver cancer, the main point of my presentation was the emphasis of multidisciplinary care as we approach patients with liver cancer. Particularly now, we are finding that if we can enroll people who are at risk in the screening program of surveillance for cancer, we can often detect the cancers at an earlier stage.
That gives us more treatment options, like liver transplantation, surgical resection, and different kinds of ablative methods to destroy tumors in the liver. The methods we had before were not appropriate for liver cancer but then [there were] changes in technology and the ability to focus radiation therapy beams on the tumor. It has really shown us that, as long as we are not treating the entire liver, we can safely treat individual tumors and have very good results. Treatments such as stereotactic body radiation therapy, and also proton beam therapy, are really emerging as important treatments for some patients with liver cancer.
Having that sense of it’s now a disease that’s treated not such individual specialties, but really by multidisciplinary groups, is the big message.
You mentioned an increase in liver cancer incidence. What are some of the lesser-known risk factors of this disease?
For a long time, the major thing that has driven the rise in liver cancer in this country is the hepatitis C virus. Up until 1990, we didn’t have any way of diagnosing hepatitis C so it became quite prevalent. Then, after people had the infection for 20 or 30 years, they would get cirrhosis or scarring of the liver, then that would lead to development of cancer in the liver. We typically think of people who are born between 1945 and 1965—those are the “boomers” generation—as being the generation that is hardest hit.
After 1990, we had tests for hepatitis C so, since then, we have been able to reduce its transmission in the population. We actually began to address hepatitis C and now, over the last 2 or 3 years, we have had very effective treatments for hepatitis C.