Dr. Abou-Alfa on Sequencing Challenges in Metastatic HCC

Ghassan K. Abou-Alfa, MD, medical oncologist at Memorial Sloan Kettering Cancer Center, discusses sequencing challenges in metastatic hepatocellular carcinoma (HCC).

One of the key struggles in HCC is deciding how to appropriately sequence the agents available, says Abou-Alfa. The question of whether sequencing should be based on physician preference, tolerance, adverse events, or patient preference is still an open one. These decisions could also be based on science, such as clinical efficacy or other biologic components, says Abou-Alfa. Admittedly, the field does not have those answers yet, adds Abou-Alfa.

The advent of combination therapies has brought everything into the first-line therapy setting, says Abou-Alfa. An additional that then arises is, "Should sorafenib (Nexavar) and lenvatinib (Lenvima) remain as the first- and second-line therapy options and all other agents be moved to the third-line setting?" Although Abou-Alfa admits that this approach might not make sense as all the drugs that are currently available are beneficial. It would not make sense to take away certain assets that might provide benefits for patients, concludes Abou-Alfa.