Ongoing trials
Daneng Li, MD, of City of Hope, in Duarte, Calif., commented: “Patients who are eligible for the combination of atezolizumab and bevacizumab should be treated in the first line. This is the new standard of care as first-line treatment for advanced HCC. If there are contraindications, then either sorafenib or lenvatinib are an option for first-line treatment. This is very consistent with what practicing clinicians are starting to recognize.” He noted that there are no large phase 3 second-line trials of a TKI after lenvatinib or a frontline combination of atezolizumab/bevacizumab.
“The new guidelines are consistent with the recent rapid advances in the landscape for the treatment of advanced HCC. They can help community practitioners who might not see as many cases of advanced HCC keep up to date,” said Dr. Li.
“Research is rapidly progressing. Currently there are at least four major first-line combination trials with dual immuno-oncoIogy therapies or immuno-oncology plus a TKI. If any of those trials are positive, the guidelines will need to be revised immediately.”
Dr. Li added: “With multiple options available, we may be able to select the ideal combination for the individual patient. We now have good options for a disease that traditionally had a poor prognosis. I believe we are at a point of making more breakthroughs. Innovative combinations really allow these patients to live longer and better lives.”
Dr. Beg reported consulting and advising for Ipsen, Boston Biomedical, Array BioPharma, and AstraZeneca/MedImmune, and receiving research funding from numerous sources in industry. Dr. Li reported grant/research support to his institution from Boston Immunotherapeutics and consulting with Ipsen, Eisai, Exelixis, Roche-Genentech, and Merck.