Dr. Bekaii-Saab on Incorporating Mechanisms of Resistance Into Treatment Selection in HCC

Tanios S. Bekaii-Saab, MD, FACP, medical oncologist, medical director, Cancer Clinical Research Office, vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discusses incorporating potential mechanisms of resistance into treatment selection in hepatocellular carcinoma (HCC).

Currently, patterns of resistance among patients with HCC remain largely misunderstood, Bekaii-Saab explains. However, theoretical and extrapolated data suggest that mechanisms of resistance will be important considerations in HCC.

In HCC, single-agent and combination strategies targeting the VEGF pathway have been significant advances that have led to improved outcomes for patients. Notably, after standard of care atezolizumab (Tecentriq) plus bevacizumab (Avastin) in the first-line setting, patients may receive cabozantinib (Cabometyx) or regorafenib (Stivarga) in the second line, Bekaii-Saab explains. Although both agents offer reasonable options, cabozantinib could theoretically be preferred to regorafenib because MET/AXL are known mechanisms of resistance to VEGF, concludes Bekaii-Saab.