Evaluating Systemic Therapies Available for Frontline Treatment of HCC

Madappa Kundranda, MD, PhD, discusses the frontline therapeutic options for patients with newly diagnosed hepatocellular carcinoma who are not candidates for surgery or transplant.

Madappa Kundranda, MD, PhD, a gastrointestinal medical oncologist at Banner MD Anderson Cancer Center, discusses the frontline therapeutic options for patients with newly diagnosed hepatocellular carcinoma (HCC) who are not candidates for surgery or transplant.

The most common option based on intrahepatic and extrahepatic involvement is systemic therapy, says Kundranda. Certain liver-directed therapies can be used in conjunction with systemic therapies when the disease is predominantly located in the liver, but there are currently 2 FDA-approved systemic agents for the frontline treatment of HCC.

Sorafenib (Nexavar) was approved in the frontline by the FDA based on data from the SHARP trial, which is over 10 years old now. The REFLECT trial led to the approval of lenvatinib (Lenvima) for the frontline treatment of HCC, says Kundranda. The CheckMate 040 trial appeared encouraging for nivolumab (Opdivo) as a frontline treatment, but data presented at ESMO determined the trial did not meet its prespecified endpoint.