Dr. Kim on Role of Frontline Immunotherapy in Advanced HCC

Richard Kim, MD, assistant professor of oncology, University of South Florida College of Medicine, medical oncologist, Department of Gastrointestinal Oncology, Moffitt Cancer Center, discusses the role of frontline immunotherapy in patients with advanced hepatocellular carcinoma (HCC).

Physicians are hopeful that data from the phase III CheckMate-459 trial will be positive, says Kim. The ongoing study is comparing nivolumab (Opdivo) monotherapy with single-agent sunitinib (Sutent) in the frontline setting. If these data are positive, nivolumab will likely become the standard of care in the frontline setting for patients with advanced HCC. Moreover, the PD-1 inhibitor appears to be better tolerated than the current VEGF TKIs that are utilized.

However, optimism with immunotherapy has waned following the results of the KEYNOTE-240 trial, Kim notes. In February 2019, Merck announced that pembrolizumab (Keytruda) plus best supportive care failed to demonstrate a statistically significant improvement in progression-free survival and overall survival versus best supportive care alone in the second-line setting. The November 2018 FDA approval of pembrolizumab in this setting was contingent on these data.

If the data with nivolumab are negative, the field may have to start from scratch in terms of immunotherapy. The future might rely on combinations of checkpoint inhibitors and VEGF TKIs, or with other types of therapy, Kim concludes.