Dr. Singal on the Utility of Frontline Lenvatinib and Sorafenib in Advanced HCC

Amit G. Singal, MD, MS, medical director, Liver Tumor Program, clinical chief, Hepatology, Dedman Family Scholar in Clinical Care, David Bruton, Jr. Professorship in Clinical Cancer Research, UT Southwestern Medical Center, discusses the utility of frontline lenvatinib (Lenvima) and sorafenib (Nexavar) in hepatocellular carcinoma (HCC).

The May 2020 FDA approval of atezolizumab (Tecentriq) in combination with bevacizumab (Avastin) established the regimen as the frontline standard for the majority of patients with unresectable or metastatic HCC, says Singal. However, some patients, such as those with advanced liver dysfunction, Child-Pugh B cirrhosis, or significant portal hypertension, are not eligible to receive the combination therapy, Singal explains. This is because the findings from the IMbrave150 trial, for which the approval of atezolizumab/bevacizumab was based on, did not include safety data regarding these patient subgroups, Singal says.

However, some safety data have been published regarding the utility of the multikinase inhibitors lenvatinib and sorafenib as frontline options for these patients and remain preferred therapeutic options, Singal says. Additionally, findings from the phase 1/2 CheckMate-040 trial demonstrated clinical activity with single-agent nivolumab (Opdivo) in patients with Child-Pugh B advanced HCC. As such, nivolumab monotherapy could also be considered for well-selected patients who are ineligible for atezolizumab/bevacizumab, concludes Singal.