Sequencing Therapies in the First and Second Line for Patients With HCC

Lipika Goyal, MD, a hematologist and medical oncologist at Massachusetts General Hospital, discusses first-line options for patients with patients with hepatocellular carcinoma (HCC).

In 1 scenario, patients can get a single-agent tyrosine kinase inhibitor (TKI) of either sorafenib (Nexavar) or lenvatinib (Lenvima) in the first-line setting, according to Goyal. The second scenario is for patients with HCC to receive atezolizumab (Tecentriq) plus bevacizumab (Avastin). There was a positive phase 3 trial of atezolizumab and bevacizumab called IMbrave50 (NCT03434379), which led to an FDA approval this year.

For the first scenario, Goyal says that if there is a clinical trial available first, she will encourage patients to consider it so they could potentially get a treatment that is not FDA-approved yet and might be better than what is FDA-approved. If the patient is not eligible or does not want to participate in a clinical trial, she will think about if they have rapid progression on the TKI, if they had poor tolerability, or if they are unlikely to be able to go onto third-line therapy. If any of those are the case, she says she is more likely to recommend a single-agent PD-1 inhibitor like nivolumab (Opdivo) or pembrolizumab (Keytruda) for the next line of therapy.

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