Dr. Bekaii-Saab on Second-Line Treatment Options in HCC

Tanios S. Bekaii-Saab, MD, FACP, leader of the Gastrointestinal Cancer Program at Mayo Clinic Cancer Center; a medical oncologist, director of the Cancer Clinical Research Office, and the vice chair and section chief for Medical Oncology in the Department of Internal Medicine at the Mayo Clinic, discusses second-line treatment options in hepatocellular carcinoma (HCC).

When thinking about all the first-line treatment options available in HCC, such as atezolizumab (Tecentriq) and bevacizumab (Avastin), the question becomes focused on which options should be used in the second-line setting, says Bekaii-Saab. Several second-line options have emerged in recent years and they all came on the heels of sorafenib (Nexavar), adds Bekaii-Saab. The field does not have much data available to inform what should be done following first-line treatment.

Today, the options in the second-line setting are regorafenib (Stivarga), cabozantinib (Cabometyx), and ramucirumab (Cyramza) if your alpha-fetoprotein is ≥400 ng/mL. Ipilimumab (Yervoy) and nivolumab (Opdivo) are also available, along with pembrolizumab (Keytruda). It has been suggested that sorafenib and lenvatinib (Lenvima) could potentially move to the second-line setting, although at this point in time, there are not enough data available to support either of those agents beyond the first-line setting, concludes Bekaii-Saab.