Dr. Hwang on First-line Treatment Options in HCC

Jimmy Hwang, MD, medical oncologist, Levine Cancer Institute, Atrium Health, discusses the current state of available first-line treatment options in hepatocellular carcinoma (HCC), and areas of continued unmet need in this space.

Patients who have HCC with preserved hepatic function have several first-line treatment options in clinical practice, Hwang begins. When considering agents being evaluated in current clinical trials, thetreatment armamentarium appears set to expand even further, he says. Previous data has shown that the use of immunotherapy alone or in combination provides greater patient benefit when compared with previous standard-of-care (SOC) TKIs like sorafenib (Nexavar) or lenvatinib (Lenvima), Hwang expands. 

Both immuno-oncology (IO)/IO combinations or IO plus VEGF TKI regimens have elicited high survival outcomes and patient responses, as well as favorable toxicity profiles, he explains. The combination of atezolizumab (Tecentriq) plus bevacizumab (Avastin) has shown considerable efficacy for patients with HCC in the frontline setting. Since its FDA approval on May 29, 2020, the regimen has become a category 1 recommendation in the National Comprehensive Cancer Network guidelines, and a SOC treatment in this space. 

Immunotherapy regimens are effective options for patients with HCC with preserved hepatic function, Hwang continues. However, the greatest challenge in HCC remains the identification of viable and effective treatment alternatives for patients who do not meet specific eligibility criteria in clinical trials, Hwang notes. There is currently a lack of definitive data on the tolerability and safety of immunotherapy and an overall need for more clarity when determining a treatment approach in this population, Hwang emphasizes. 

It is especially important to address this challenge through future research, as these patients comprise a significant proportion of the overall population in HCC, Hwang concludes.