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Therapeutic Advancements Changing Liver Cancer Paradigm

Danielle Bucco
Published: Monday, Sep 25, 2017

Steven R. Alberts, MD
Steven R. Alberts, MD
For nearly a decade after the 2007 approval of sorafenib (Nexavar), there were no new therapies approved for HCC. However, there are now new drugs showing promise, according to Steven R. Alberts, MD.

on GI Malignancies, Alberts, a professor of oncology in the College of Medicine, consultant in the Division of Medical Oncology at Mayo Clinic, discussed current advancements being made for patients with advanced liver cancer.

OncLive: Please provide an overview of your presentation.

Alberts: I went over some updates regarding the treatment of patients with advanced liver cancer. I spent some time reviewing the management of smaller, localized tumors that may be treated with embolization. However, the bulk of the talk was focused on systemic therapy for advanced disease. 

What regimens are looking promising for advanced liver cancer?

It is an interesting time in liver cancer. For many years, it was sorafenib and not much else. There were a lot of trials that had been conducted in early phases that showed promising results, but none of those made it to FDA approval until regorafenib. Since then, there have been several drugs heading toward hopefully successful trials.

One of those promising drugs was presented this year at the 2017 ASCO Annual Meeting with a drug called lenvatinib, which is mainly used for thyroid cancer, but, compared with sorafenib, showed comparable outcomes. That is a drug that likely will gain FDA approval.

Is lenvatinib being looked at in combination or only as a single agent?

Right now, it is being looked at as a single agent. It has some unique toxicities. Until there is a better understanding of how that drug is working in HCC and what populations of patients might benefit from it, the main focus of it will be single-agent therapy. 

What other ongoing trials are you interested in?

One of the trials right now is with the drug cabozantinib (Cabometyx) that has been ongoing for a while looking at the use of cabozantinib versus placebo. The trial should be near its final accrual with the hope that there may be some results coming out of that in the near future. 

Where are we with biomarker research?

Biomarker research continues to be a very active area.  A lot of interest has been focused on markers that could be used for antiangiogenic agents. To date, across most types of cancer, the VEGF receptors, VEGF levels, or other markers of angiogenesis have not worked out as well as we thought.

c-MET inhibition has been of interest, mainly because of cabozantinib, and had been of interest with another drug that was a c-MET inhibitor but, unfortunately, did not move forward. 

What are the most prominent challenges that you would like to see addressed?

As an oncologist, we’re always interested in what is the best possible drug for somebody with advanced disease. When you think about a lot of cancers, and HCC certainly one of those, a good portion of the cancers are preventable. With better treatments for viral hepatitis, whether it is the vaccination for hepatitis B or some newer treatment for hepatitis C that has been making impact.

Unfortunately, looming on the horizon right now is nonalcoholic steatohepatitis. That is leading to liver disease, is rapidly increasing in the United States, and will become a dominant cause of HCC in the future.

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