Addressing How to Treat Patients With Advanced Hepatocellular Carcinoma

Mehmet Akce, MD, an assistant professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine, discusses how he treats patients with advanced hepatocellular carcinoma (HCC) in the first-line setting.

Akce says he starts with the utilization of atezolizumab (Tecentriq) and bevacizumab (Avastin) in combination based on data from the IMbrave150 trial (NCT03434379). Because of the inclusion and exclusion criteria of the trial, he would caution use of this combination in patients who have untreated varices since this trial required patients with varices to be treated and anyone with variceal bleeding in the 6 months prior were excluded from the trial. In those 2 groups of patients, there is no safety data.

Akce restricts his use of this regimen to patients with Child Pugh A. As long as patients don’t have any conditions that were not studied in the trial, he feels comfortable using this combination in the frontline setting because it has been shown to be superior to sorafenib (Nexavar) in the first line.

Since this combination is not suitable for every patient, lenvatinib (Lenvima) is a good option for a patient with Child Pugh A, according to Akce. The trial for this agent excluded patients with portal vein invasion and those with a liver tumor occupying more than 50% of their liver, which should be kept in mind when treating patients.

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