Dr. El-Khoueiry on Immunotherapy Combinations in HCC

Anthony B. El-Khoueiry, MD, associate professor of clinical medicine, Keck School of Medicine, USC Norris Comprehensive Cancer Center, discusses immunotherapy combination in hepatocellular carcinoma (HCC).

There are several combinations of immuno-oncology (IO) agents plus other IO agents under investigation. One of the most promising combinations is PD-1/L1 inhibition with CTLA-4 inhibition. Additionally, there is the phase III HIMALAYA trial, which is combining durvalumab (Imfinzi) and tremelimumab versus durvalumab alone versus sorafenib (Sutent) in the frontline setting. Furthermore, data from a phase II cohort of nivolumab (Opdivo) plus ipilimumab (Yervoy) are anticipated.

There is also rationale to combine PD-1 inhibitors with anti-VEGF targeted therapies, says El-Khoueiry. For example, the combination of pembrolizumab (Keytruda) and lenvatinib (Lenvima), which has shown a promising early signal. There are also combinations of nivolumab and sorafenib as well as nivolumab and lenvatinib in ongoing trials. The combination of atezolizumab (Tecentriq) with bevacizumab (Avastin) is also worth mentioning, adds El-Khoueiry, as this combination has shown an objective response rate (ORR) of approximately 30%. Investigators are still working to determine whether the toxicity of these combinations is tolerable and whether the improvement in ORR will translate to improved overall survival.