Dr. Abou-Alfa on Progress Made in Hepatocellular Carcinoma

Ghassan K. Abou-Alfa, MD, medical oncologist at Memorial Sloan Kettering Cancer Center, discusses the progress that has been made in the treatment of patients with hepatocellular carcinoma (HCC).

Sorafenib (Nexavar) is 1 of 7 agents to receive regulatory approval in HCC, says Abou-Alfa. Sorafenib and lenvatinib (Lenvima) are first-line options. In the second-line setting, regorafenib (Stivarga), which is conditional on prior sorafenib exposure, cabozantinib (Cabometyx), and ramucirumab (Cyramza), which requires high alpha-fetoprotein are also approved for use. In addition, nivolumab (Opdivo) and pembrolizumab (Keytruda) are approved for use as monotherapy following prior exposure to sorafenib. The availability of these drugs and investigational combination therapies has prompted several questions regarding optimal sequencing strategies, says Abou-Alfa.

Notably, the combination of bevacizumab (Avastin) and atezolizumab (Tecentriq) showed promise as frontline therapy, according to results from the phase III IMbrave150 trial presented at the 2019 ESMO Asia Congress. In addition, the frontline combination of lenvatinib plus pembrolizumab demonstrated encouraging results in the phase Ib KEYNOTE-524/Study 116 trial; results from the phase III trial are pending. Another combination of interest is durvalumab (Imfinzi) and tremelimumab, which is under investigation as frontline therapy in the phase III HIMALAYA trial, concludes Abou-Alfa.