Michael R. Charlton, MD, MBBS


Michael R. Charlton, MD, MBBS, professor of medicine, director of the Center for Liver Diseases, and codirector of the Transplant Institute at the University of Chicago Medicine, discusses the impact of the LEGACY trial investigating yttrium-90 radioembolization in patients with solitary, unresectable hepatocellular carcinoma (HCC).

Even though the pandemic has hindered many clinical trials, Charlton feels there have been tremendous steps forward in the HCC setting. The progress stems from the groundwork for the major studies that were already in place before the pandemic. One of these studies was the LEGACY trial conducted at Northwestern Feinberg School of Medicine in Chicago, Mount Sinai Health System in New York, among other institutions. This study looked at radioembolization of single lesions up to 8 cm in size that were not resectable.

Many patients with these lesions usually receive locoregional therapy and then transplantation if they are eligible. Charlton says that physicians for HCC should rethink that strategy because liver transplantation can be difficult on patients and not always available for those who need it. The 5-year survival rates in the LEGACY study were comparable with the survival of standard-of-care methods. There are likely groups of patients who are being over-treated in this setting with locoregional therapy and liver transplantation, according to Charlton. Patients with Child-Pugh A HCC after hepatitis C cure might do well with this radioembolization.

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Michael R. Charlton, MD, MBBS, discusses the impact of the LEGACY trial investigating yttrium-90 radioembolization in patients with solitary, unresectable hepatocellular carcinoma.

LEGACY Trial of Radioembolization Shows Practice-Changing Data in HCC

Michael R. Charlton, MD, MBBS, professor of Medicine, director of the Center for Liver Diseases, and co-director of the Transplant Institute at the University of Chicago Medicine, discusses different types of therapy and trials in the hepatocellular carcinoma (HCC) setting right now.

The different groups of therapies being looked at in this setting are tyrosine kinase inhibitors, oral and intravenous treatment, and checkpoint inhibitor therapies. Many of these therapies are being used in combination. Charlton identifies cabozantinib (Cabometyx) being used with the checkpoint inhibitor nivolumab (Opdivo). He mentions the IMbrave150 trial, which investigated bevacizumab (Avastin) and the checkpoint inhibitor atezolizumab (Tecentriq).

The outcomes of patients with HCC have seen improvement in progression-free survival and overall survival. Charlton thinks that this is an area in the HCC landscape which has had difficulty making headway in the past. He says the previous guidelines that are only a year old are no longer current, which is great. He and his colleagues spoke to each other about having guidelines that are actively being updated, so they reflect data as they emerge instead of waiting 1 or 2 years for the field to agree that using a specific regimen is the correct thing to do.

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Michael R. Charlton, MD, MBBS, discusses different types of therapy and trials in the hepatocellular carcinoma setting right now.

Michael R. Charlton, MD, MBBS | Authors

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