Laura A. Dawson, MD, FRCPC, discusses key takeaways from the NRG/RTOG 1112 study of stereotactic body radiation therapy followed by sorafenib vs sorafenib alone in patients with hepatocellular carcinoma.
Laura A. Dawson, MD, FRCPC, chair and professor of radiation oncology at Princess Margaret Cancer Centre, Toronto, Ontario, discusses key takeaways from the NRG/RTOG 1112 study (NCT01730937) of stereotactic body radiation therapy (SBRT) followed by sorafenib (Nexavar) versus sorafenib alone in patients with hepatocellular carcinoma (HCC).
The study showed an improvement in efficacy with SBRT without an increase in serious adverse events versus sorafenib alone. Following the results from the IMbrave150 trial (NCT03434379), sorafenib is no longer the standard of care in HCC based on the superiority of bevacizumab (Avastin) plus atezolizumab (Tecentriq). However, Dawson says the study still shows that adding SBRT is an option that can make an impact for many patients, considering that many are ineligible for immunotherapy or other systemic therapies, and some may receive sorafenib or lenvatinib (Lenvima) in the second line.
Dawson recommends referring appropriate patients to a radiation oncologist and considering whether it is the right time for them to receive radiotherapy. Physicians should consider this approach for patients with HCC who have a comorbidity or other condition that makes them ineligible for the IMbrave150 regimen or other systemic options, as it can have a major impact on overall survival without significantly increasing toxicity, according to Dawson.
0:08 | I think it is important to remember that external beam radiation is a treatment option for patients. Not all patients are eligible for immunotherapy or other systemic therapies. There still is a small role in North America for tyrosine kinase inhibitor treatment. Even after first-line therapy with immunotherapy, some patients may be eligible for sorafenib or lenvatinib, another tyrosine kinase inhibitor.
0:35 | In these patients, it is important to remember that radiotherapy can have quite a profound impact, so ask about a referral to radiation oncologists and consider whether it's the right time to treat patients. Especially patients who are not well suited for any systemic therapy, so who have similar advanced disease that has presented, but for some reason—a recent MI [myocardial infarction] or a comorbidity—make them not well suited for systemic therapy, remember that external beam radiotherapy can help patients and make those referrals. It's not a new therapy but is a relatively new therapy to be recognized in the armamentarium to treat patients with liver cancer. Hopefully, community oncologists will work with their radiation oncology teams and refer more patients for radiation therapy.