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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Sequencing of systemic treatment for hepatocellular carcinoma: Second line competitors
Federico Piñero1, Marcelo Silva1, Massimo Iavarone2
1Hospital Universitario Austral, Facultad de Ciencias Biomédicas, Universidad Austral, Buenos Aires B1629HJ, Argentina.
Abstract:
During the last decades, further knowledge of hepatocellular carcinoma (HCC) molecular mechanisms has led to development of effective systemic treatments including tyrosine kinase inhibitors (TKIs) and immunotherapy. In this review, we describe first and second line systemic treatment options for advanced HCC. Several trials have evaluated new drugs for the treatment of HCC patients: In first line, lenvatinib resulted non-inferior to sorafenib and it can be used as alternative, even in the lack of evidence for sequential treatment options in second line after lenvatinib. Recently, atezolizumab plus bevacizumab have shown superiority over sorafenib in first-line. Sorafenib-regorafenib sequential administration in selected patients has opened a new paradigm of treatment in advanced HCC with a life expectancy exceeding two years. Other TKIs for second line treatment include cabozantinib and ramucirumab (specifically for patients with Alpha-fetoprotein values ≥ 400 ng/mL). The combination of TKIs with immunotherapy may represent a big step forward for these patients in the near future.
Insights
Advanced hepatocellular carcinoma (HCC) treatments now include tyrosine kinase inhibitors (TKIs) and immunotherapy. Lenvatinib and atezolizumab plus bevacizumab offer new first-line options, while sequential sorafenib-regorafenib and other TKIs provide second-line choices.
Area of Science:
- Hepatocellular Carcinoma (HCC) Molecular Mechanisms
- Systemic Treatment Modalities
Background:
- Recent decades have seen significant advancements in understanding HCC molecular pathways.
- This knowledge has driven the development of effective systemic therapies, including tyrosine kinase inhibitors (TKIs) and immunotherapy.
Purpose of the Study:
- To review current first and second-line systemic treatment options for advanced HCC.
- To highlight novel therapeutic strategies and their efficacy in HCC management.
Main Methods:
- Review of clinical trials evaluating systemic drugs for HCC.
- Analysis of first-line and second-line treatment efficacy and safety profiles.
Main Results:
- First-line: Lenvatinib is non-inferior to sorafenib; atezolizumab plus bevacizumab demonstrates superiority over sorafenib.
- Second-line: Sequential sorafenib-regorafenib offers improved survival; cabozantinib and ramucirumab (for AFP ≥ 400 ng/mL) are other options.
- Sequential treatment options after lenvatinib require further evidence.
Conclusions:
- Several effective first and second-line systemic treatments are available for advanced HCC.
- Sequential administration strategies, like sorafenib-regorafenib, are improving patient outcomes.
- Future research focusing on combining TKIs with immunotherapy holds promise for enhanced HCC treatment.
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