Ruth He, MD, highlights factors that influence her use of frontline systemic therapy in patients with unresectable hepatocellular carcinoma.
Ruth He, MD:The treatment goal of frontline systemic therapy is to prolong patients’ overall survival and preserve patients’ quality of life in addition to liver function. When I start the patient on systemic therapy, patient-related factors that I consider include whether this patient will be compliant with oral treatment. If not, I would consider intravenous combination. Does the patient already have significant fatigue? If so, then I would avoid giving a TKI [tyrosine kinase inhibitor]. I also will look at the disease-related factors.
I will assess the risk of bleeding in this patient. Is this patient symptomatic from the cancer that required a big response—and significant tumor shrinkage from the treatment—or not? Is so, then I would consider a treatment that has a higher response rate that hopefully will shrink the tumor significantly to decrease the symptoms.
Under NCCN [National Comprehensive Cancer Network] Guidelines, 3 systemic therapy options are category 1 recommendations supported by randomized phase 3 trials: sorafenib by the SHARP trial, lenvatinib by the REFLECT trial, and the combination of bevacizumab and atezolizumab supported by the IMbrave150 clinical trials.
Transcript edited for clarity.