Ghassan K. Abou-Alfa, MD, discusses the therapies being used to treat patients with hepatocellular carcinoma right now.
Ghassan K. Abou-Alfa, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center, discusses the therapies being used to treat patients with hepatocellular carcinoma (HCC) right now.
Treatment selection for patients requiring systemic therapy is dependent on many choices. Before there was only 1 choice, but now there are almost 8 choices, Abou-Alfa says. Sorafenib (Nexavar) and lenvatinib (Lenvima), which are both effective tyrosine kinase inhibitors, are available in the first-line setting. There is also a new advancement in the first line, which is the combination of atezolizumab (Tecentriq) plus bevacizumab (Avastin).
In the second-line setting, regorafenib (Stivarga) with a condition of prior sorafenib exposure is available, as well as cabozantinib (Cabometyx) in second and third line. Ramucirumab (Cyramza) is an option for patients with HCC and a high alpha-fetoprotein level of more than 400 ng/mL at baseline. Nivolumab (Opdivo) is available as a single agent or in combination with ipilimumab (Yervoy), and also pembrolizumab (Keytruda) as a single agent.
This landscape evolved quite a bit, and with the advent of new therapies, a lot of new challenges have come up, according to Abou-Alfa. A lot of clarity is needed in regard to how to sequence those therapies and how to treat patients, and the landscape is still evolving.