HCC

An expert discusses how treatment selection for first-line (1L) tyrosine kinase inhibitor (TKI) therapy in advanced hepatocellular carcinoma (HCC) requires careful evaluation of multiple factors, including liver function (Child-Pugh status), ECOG performance status, tumor burden, and presence of macrovascular invasion or extrahepatic spread. In reviewing individual cases, clinicians assess liver enzyme levels, α-fetoprotein values, radiographic findings, and comorbidities.

Panelists discuss how combining systemic therapy with locoregional treatments like transarterial chemoembolization (TACE) aims to enhance therapeutic efficacy by addressing its limitations, such as incomplete tumor necrosis and hypoxia-induced progression. Tyrosine kinase inhibitors (TKIs) like lenvatinib and immune checkpoint inhibitors (ICIs) counteract TACE-induced resistance by inhibiting angiogenesis and boosting immune response, improving overall tumor control.

Panelists discuss how systemic therapy plays a crucial role in embolization-eligible hepatocellular carcinoma (HCC), particularly for patients with progressive or extensive disease. In locally advanced cases, systemic therapies, including immunotherapy combinations and tyrosine kinase inhibitors (TKIs), are first-line options. Patients typically transition from transarterial chemoembolization (TACE) to systemic therapy upon progression, high tumor burden, or liver function decline.

The panelist discusses how for patients initially eligible for embolization, systemic therapy may be combined with transarterial chemoembolization (TACE) upfront for high-risk disease (ie, large tumor burden, elevated AFP) or reserved for progression after regional therapy in lower-risk cases. Treatment decisions should be individualized based on tumor characteristics, liver function, and patient preferences.

The panelist discusses how the patient underwent transarterial chemoembolization (TACE) 3 times with an initial partial response. However, at the end of the 6-month treatment period, the patient had disease progression. The panelist advises that the best treatment option for the patient would be systemic therapy.

An expert discusses how first-line (1L) systemic therapy for unresectable hepatocellular carcinoma (uHCC) has evolved significantly from sorafenib monotherapy to include combination approaches such as atezolizumab plus bevacizumab, which demonstrated superior outcomes in the IMbrave150 trial. Key challenges include underlying liver dysfunction, heterogeneous tumor biology, and managing adverse events while preserving quality of life. Treatment goals focus on extending survival while maintaining liver function and performance status. The shift toward immunotherapy-based combinations has improved outcomes, though patient selection and sequencing strategies remain important considerations in optimizing first-line treatment decisions in clinical practice.

An expert discusses the patient case of a 57-year-old woman diagnosed with advanced unresectable hepatocellular carcinoma. The patient presented with abdominal pain, fatigue, and loss of appetite. She also has a history of Crohn disease, which is being controlled with infliximab. The patient also has a history of variceal bleeding and has been treated with antiviral therapy for chronic hepatitis B virus infection.

The panelist discusses first-line options including atezolizumab plus bevacizumab, lenvatinib, and sorafenib. Second-line treatments include regorafenib, cabozantinib, and ramucirumab. Clinical trials should be prioritized when available.

The panelist discusses the case of a 60-year-old man diagnosed with unresectable hepatocellular carcinoma (HCC). The patient has a history of metabolic dysfunction-associated steatohepatitis managed with lifestyle changes and medication. Initially, there was no clinical or radiographic evidence of cirrhosis. The patient recently presented to his gastroenterologist complaining of abdominal pain in the upper right quadrant and fatigue.

During a Case-Based Roundtable® event, Pierre Gholam, MD, discussed how post hoc and real-world analyses build upon the limited available trial data for treating patients with unresectable hepatocellular carcinoma with Child-Pugh B status.

The FDA approved a phase 3 trial to assess amezalpat with the current standard of care in unresectable or metastatic hepatocellular carcinoma.

The new drug application resubmission of rivoceranib/camrelizumab in the first line in unresectable or metastatic hepatocellular carcinoma is supported by the final survival analysis of CARES-310 trial.

A new drug application has been resubmitted to the FDA for the combination of camrelizumab and rivoceranib as a first-line treatment for unresectable hepatocellular carcinoma, following a complete response letter in May 2024.

The HIMALAYA study showed that the combination of tremelimumab and durvalumab significantly improved overall survival in patients with hepatocellular carcinoma.

A combination of lenvatinib, pembrolizumab, and TACE significantly improved progression-free survival in patients with intermediate-stage hepatocellular carcinoma compared to dual placebo and TACE.

The application is supported by the phase 3 CheckMate -9DW study, and the FDA has set a target action date of April 21, 2025.

During a Case-Based Roundtable® event, Pierre Gholam moderated a discussion on how to proceed with a patient presenting with a LI-RADS 5 mass suspected of being hepatocellular carcinoma.

The FDA has given positive feedback on the planned phase 3 study for the combination of amezalpat, atezolizumab, and bevacizumab in the first-line treatment of unresectable or metastatic hepatocellular carcinoma.

A phase 1 trial is evaluating treatment with MT-303 in patients with hepatocellular carcinoma to determine its safety, pharmacokinetics, pharmacodynamics, and preliminary efficacy.

With extended follow-up, the combination of investigational agents rivoceranib and camrelizumab demonstrated a significant survival benefit vs sorafenib in advanced, unresectable hepatocellular carcinoma.

The combination of camrelizumab and rivoceranib significantly improved survival rates in patients with unresectable liver cancer compared with standard treatment.

During a live Community Case Forum event in partnership with the Tennessee Oncology Practice Society, Pierre Gholam, MD, examined the current state of treatment for patients with hepatocellular carcinoma, looking in particular at what data is available for those with Child-Pugh B and C status who have poorer outcomes and have limited data from prospective clinical trials.

In a retrospective study in patients with hepatocellular carcinoma, 40% of patients developed irAEs after receiving the first and second doses of immunotherapy.

In the frontline, patient body mass index plays a prognostic role when using atezolizumab plus bevacizumab vs lenvatinib for patients with advanced hepatocellular carcinoma.

No differences in efficacy and safety were seen in a study cohort of 1325 patients undergoing frontline treatment with lenvatinib for unresectable hepatocellular carcinoma.

The phase 3 CheckMate -9DW study of frontline nivolumab plus ipilimumab in hepatocellular cancer met its primary end point of overall survival vs sorafenib or lenvatinib.

In an interview for Cholangiocarcinoma Awareness Day, Domenech Asbun, MD, discussed how the management of cholangiocarcinoma continues to evolve and addressed unmet needs in early detection and systemic therapy.

In an interview with Targeted Oncology, Bruno Sangro, MD, PhD, discussed the potential durvalumab, bevacizumab, and TACE has to set a new standard-of-care among patients with unresectable hepatocellular carcinoma.

The FDA granted a fast track designation to BST02 for patients with all forms of liver cancer.