Dr. Singal on Systemic Therapies in HCC

Amit G. Singal, MD, associate professor, UT Southwestern Medical Center, discusses systemic therapies in hepatocellular carcinoma (HCC).

Several advances have been made with systemic therapy in HCC, says Singal. For example, the phase III IMbrave150 trial demonstrated a 42% reduction in the risk of death with the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) compared with sorafenib (Nexavar) in patients with unresectable HCC who did not receive prior systemic therapy.

In January 2020, a supplemental biologics license application was submitted to the FDA for the combination. Pending approval, atezolizumab/bevacizumab will likely become the frontline standard of care for these patients, says Singal.

In the second-line setting, TKIs, VEGF inhibitors, and checkpoint inhibitors have demonstrated activity in patients with HCC. While these therapies are typically administered by medical oncologists, it is important to establish an open dialogue with a hepatologist as most patients with HCC have concurrent chronic liver disease or cirrhosis, says Singal.

Ultimately, some patients can be downstaged with these novel therapies, and can be considered for locoregional therapy rather than systemic therapy, concludes Singal.