Ghassan K. Abou-Alfa, MD, discusses the significance of disease etiology when exploring the results of recent trials of patients with unresectable hepatocellular carcinoma.
Ghassan K. Abou-Alfa, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center, discusses the significance of disease etiology when exploring the results of recent trials of patients with unresectable hepatocellular carcinoma (HCC).
Abou-Alfa says that studies of new regimens have included varying proportions of patients with hepatitis B etiology, which can be explained by geographic location of these studiesand could influence their outcomes. The IMbrave150 trial (NCT03434379) of the combination of bevacizumab (Avastin) plus atezolizumab (Tecentriq) had 49% with hepatitis B etiology, and real-world data on this combination had under 40% with hepatitis B etiology. The LEAP-002 (NCT03713593) trial of pembrolizumab (Keytruda) plus lenvatinib (Lenvima) had approximately 50% of patients with this etiology.
Abou-Alfa notes that the China-based phase 3 trial (NCT03764293) investigating camrelizumab (SHR-1210) plus rivoceranib had approximately 75% hepatitis B etiology patient population, and this population could contribute to the favorable efficacy in the trial.
Finally, the HIMALAYA trial (NCT03298451), which led to the approval of durvalumab (Imfinzi) plus tremelimumab (Imjudo) had approximately 30% with hepatitis B, 30% with hepatitis C, and 40% with nonviral etiology. Abou-Alfa says that this global study, which is the largest in this setting with 1400 patients, is a good reference point based on its representation of disease etiologies. He says it may become necessary to conduct trials based on etiology to distinguish its impact on treatment efficacy, or further study the immune microenvironment to see what variables lead to different outcomes with immunotherapy in HCC.
TRANSCRIPTION:
0:08 | What is the key element here? I would say it's probably all about the etiology. No. 1: in the real-world data from the atezolizumab plus bevacizumab, there were less than 50% of patients of the IMbrave150 that were positive for hepatitis B. No. 2 is the very robust results that we have seen for the camrelizumab plus rivoceranib is dependent on 75% of the patients with hepatitis B and to add to this, 50% of the patients had hepatitis B in regard to the lenvatinib plus pembrolizumab. Interestingly, in the real-world data, however, the percentage with hepatitis B was only about 30% to 40%. Interestingly, the same thing applies for the patients in the HIMALAYA study, which was only 30%.
0:56 | Clearly, etiology does play a role, and you can get more benefit here and there. Could it be that now the future is that, No. 1, we have a dynamic field and we have to settle for what would be a good reference point for us? I would say, as an example, durvalumab/tremelimumab because it's a global study with 1400 patients; it’s the largest study ever. At the same time, it includes 30% with hepatitis B, 30% with hepatitis C, and 40% non-viral, probably a good representation. No. 2, could it be that we have to start delineating the patients based on the specific etiology and do different trials? Time will tell. No. 3…the immune microenvironment with other variables could be analyzed, and of course, this is [something] to think of as well.
SELECT Trial Establishes Lenvatinib’s Role in RAI-Refractory DTC
May 2nd 2024In an interview with Targeted Oncology, Lori J. Wirth, MD, delved into how the data from SELECT signals lenvatinib effectiveness as a frontline therapy for patients with RAI-refractory differentiated thyroid cancer.
Read More
Gholam Analyzes Treatment Outcomes for Advanced HCC in Child-Pugh B Population
April 28th 2024During a live Community Case Forum event in partnership with the Tennessee Oncology Practice Society, Pierre Gholam, MD, examined the current state of treatment for patients with hepatocellular carcinoma, looking in particular at what data is available for those with Child-Pugh B and C status who have poorer outcomes and have limited data from prospective clinical trials.
Read More