ASCO GI 2021 OS Update: IMbrave150 - Episode 1

Frontline Systemic Therapy in HCC Patients

February 22, 2021
Targeted Oncology

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.