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Systemic Treatment Options in Hepatocellular Carcinoma
Lorenza Rimassa1, Tiziana Pressiani1, Philippe Merle2
1Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy.
Liver Cancer
|December 5, 2019
Summary
Systemic therapies for advanced hepatocellular carcinoma (HCC) are rapidly evolving. New agents and treatment sequences offer improved options, but careful patient selection and tolerance assessment are crucial for effective advanced HCC management.
Area of Science:
- Hepatocellular Carcinoma Research
- Oncology Drug Development
- Clinical Trial Analysis
Background:
- Advanced hepatocellular carcinoma (HCC) historically had limited treatment options with poor survival.
- Sorafenib was the sole approved systemic therapy, with no agents available post-progression.
- Recent years have seen significant advancements with multiple new drug approvals and positive trial outcomes.
Purpose of the Study:
- To provide a comprehensive overview of systemic agents approved for advanced HCC.
- To discuss clinical trial design, biomarker use, and efficacy assessment in HCC.
- To summarize ongoing and future clinical trials in advanced HCC treatment.
Main Methods:
- Review of clinical trial data for approved systemic agents (sorafenib, regorafenib, nivolumab, lenvatinib, pembrolizumab, cabozantinib).
- Analysis of recent positive phase II/III trial results (e.g., ramucirumab).
- Discussion of implications of trial design features for real-world practice.
Main Results:
- Multiple systemic agents are now approved for advanced HCC, expanding treatment options beyond sorafenib.
- Recent approvals in 2018 include lenvatinib, pembrolizumab, and cabozantinib.
- Ongoing trials and emerging data suggest a dynamic future treatment landscape.
Conclusions:
- The treatment landscape for advanced HCC is rapidly changing with new therapeutic options.
- Treatment sequencing is complex and requires consideration of patient selection and tolerance.
- Effective management of advanced HCC necessitates awareness of evolving systemic therapies.