David J. Pinato, MD, PhD

David J. Pinato, MD, PhD, clinical senior lecturer in medical oncology, clinician scientist, and consultant medical oncologist in the Department of Surgery and Cancer at Imperial College London, discusses past and current trials that are significant for the hepatocellular carcinoma (HCC) patient population.

Atezolizumab (Tecentriq) and bevacizumab (Avastin) demonstrated superiority over sorafenib (Nexavar) for overall survival, progression-free survival, overall response rate, and patient-reported outcomes in the IMbrave150 study (NCT03434379). Pinato thinks there is plenty of evidence to show that this combination will make transformative changes to the advanced HCC setting.

Trials that are expected to report data soon for immunotherapy doublets, such as CTLA4 plus PD-1 combinations. These trials are in the frontline setting for patients with HCC. Pinato says that the frontline space will become crowded over the next few months and years. He feels that tyrosine kinase inhibitors (TKIs) will always play a role in the treatment for these patients, but the position of these therapies will shift based on the duration of response, likelihood of response, and extent of clinical benefit in patients. There is interest in this setting on how the introduction of combination immunotherapy might move TKI treatment to a later line of therapy, which has happened in other cancer settings before.

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David J. Pinato, MD, PhD, discusses past and current trials that are significant for the hepatocellular carcinoma patient population.

Exploring Current and Upcoming Therapies for Hepatocellular Carcinoma

David J. Pinato, MD, PhD, clinical senior lecturer in medical oncology, clinician scientist, consultant medical oncologist, Department of Surgery and Cancer, Imperial College London, discusses the importance of utilizing a multidisciplinary approach when treating patients with hepatocellular carcinoma (HCC) and how this approach helps optimize patient outcomes now as well as how it will help in the near future as more therapies emerge.

Patients with HCC often shift from locoregional or radical care to palliative care, which makes it crucial that physicians have an ongoing multidisciplinary effort when managing these patients, says Pinato. As new treatments become available, however, he believes we will begin to see that link between good management of underlying liver function with good oncologic management.

All physicians are here to maximize the oncological outcomes for patients with HCC, says Pinato. Overall survival is key in this, and he does not think this is achievable without the work of a multidisciplinary team. Everyone needs to work together to optimize survival in these patients.

David J. Pinato, MD, PhD, discusses the importance of utilizing a multidisciplinary approach when treating patients with hepatocellular carcinoma and how this approach helps optimize patient outcomes now as well as how it will help in the near future as more therapies emerge.

Optimizing Treatment Approaches for Hepatocellular Carcinoma

David J. Pinato, MD, PhD, clinical senior lecturer in medical oncology, clinician scientist, and consultant medical oncologist, Department of Surgery and Cancer, Imperial College London, discusses the approach to selecting the appropriate frontline agent for patients with hepatocellular carcinoma (HCC). Sorafenib (Nexavar) has been around for many years, but now that lenvatinib (Lenvima) is FDA approved as well, physicians can now choose between the 2 agents.

The phase III REFLECT trial demonstrated that lenvatinib is noninferior to sorafenib in treating patients with HCC. Pinato notes that this is especially noted in patients with less than 50% occupancy of liver deposits and those without main portal vein thrombosis. In countries where both lenvatinib and sorafenib are options for the frontline treatment of HCC, drug selection relies on the toxicity profile rather than biomarkers of efficacy, as in other cancer types.

David J. Pinato, MD, PhD, discusses the approach to selecting the appropriate frontline agent for patients with hepatocellular carcinoma. Sorafenib has been around for many years, but now that lenvatinib is FDA approved as well, physicians can now choose between the 2 agents.

Adverse Events Inform Treatment Decisions in HCC for Frontline Lenvatinib Versus Sorafenib

David J. Pinato, MD, PhD, NIHR Academic Clinical Lecturer in Medical Oncology, resident, Royal Brompton Hospital and Imperial College London, discusses an analysis of intra-tumor heterogeneity in the regulation of immune-tolerogenic pathways in primary and metastatic hepatocellular carcinoma (HCC).&nbsp;

David J. Pinato, MD, PhD | Authors

Articles

Exploring Current and Upcoming Therapies for Hepatocellular Carcinoma

Optimizing Treatment Approaches for Hepatocellular Carcinoma

Adverse Events Inform Treatment Decisions in HCC for Frontline Lenvatinib Versus Sorafenib

Intra-Tumor Heterogeneity in Primary and Metastatic HCC