ASCO 2021 Liver Cancer Update

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ASCO 2021 Virtual Meeting

Medical writer: Coco Chong | Last updated: 11 June 2021 | In: Gastrointestinal Cancer, Oncology, ASCO 2021 Annual Meeting, Chemotherapy, Immunotherapy, Targeted Therapies

Article Keywords

camrelizumab, liver cancer, pembrolizumab, ASCO 2021, atezolizumab, FOLFOX, lenvatinib, hepatic arterial infusion chemotherapy, HCC, huachashu, bevacizumab, toripalimab, sorafenib, chemotherapy, apatinib, icaritin

The liver cancer trials presented at American Society of Clinical Oncology (ASCO) 2021 were mainly focused on first-line treatments, with a few trials in the neoadjuvant, adjuvant and second-line setting.

The use of neoadjuvant transarterial infusion before hepatectomy showed a significant improvement in overall survival (OS) and progression-free survival (PFS) (p=0.016 and 0.017, respectively) for resectable Barcelona Clinic Liver Cancer (BCLC) stage A/B hepatocellular carcinoma (HCC) patients beyond Milan criteria.¹ In the neoadjuvant setting, camrelizumab in combination with apatinib for advanced HCC patients also demonstrated an improvement in major pathologic response (MPR) of 29.4%.²

In the first-line the results of a number of trials were reported. Icaritin significantly improved median overall survival (mOS) over huachashu in composite biomarker score-positive (composite biomarker score) patients with combined risk/poor prognosis factors such as BCLC stage C, hepatitis B virus infection and thrombocytopenia, with a reported mOS of 13.54 months vs 7.06 months (HR=0.40; 95% CI: 0.21-0.77; p=0.0046).³ The combination treatment of lenvatinib and AK104 also showed a promising anti-tumour effect with an overall response rate (ORR) of 44.4% and disease control rate (DCR) of 77.8%.⁴ Lenvatinib was also used as first-line in combination with toripalimab plus hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients, with a 6-month PFS of 80.6%, median progression-free survival (mPFS) of 10.5 months (95% CI: 6.21−14.79) and ORR of 63.9% (95% CI: 40.9−73.0), denoting anti-tumour activity.⁵In the IMbrave 150 trial, the combination of atezolizumab plus bevacizumab reported an improved OS (HR=0.62; 95% CI: 0.34-1.11) and PFS (HR=0.62; 95% CI: 0.35-1.09) over sorafenib.⁶ Exploratory analysis demonstrated responders have not shown any landmarks (HR=0.02; 95% CI: 26.2-NE)⁷

In the KEYNOTE-224 and -240 trials, pembrolizumab was evaluated as both first- and second-line treatment, and demonstrated a consistent improvement and benefit:risk profile. In the first-line single-arm treatment, a mOS of 17 months (95% CI: 8-NA), median time to progression (mTTP) and mPFS of 4 months (95% CI: 3-8; 95% CI: 2-6) were reported, suggesting a long-lasting anti-tumour effect.⁸Pembrolizumab was also evaluated in advanced HCC patients previously treated with sorafenib, and an OS and PFS of 13.9 months and 3.3 months (95% CI: 2.8-4.1), respectively, was recorded over placebo. Although statistical significance was not reached, results support the safety and benefit:risk profile of pembrolizumab.⁹

When used in first- and second-line treatments, the combination of camrelizumab and apatinib demonstrated a prolonged OS of 20.1 months (95% CI: 14.9-NR) and 21.8 months (95% CI: 17.3-26.8) respectively, suggesting that this is a promising combination therapy in advanced HCC patients.¹⁰

FOLFOX-based HAIC regimens (HAIC-FO) chemotherapy was compared against sorafenib on patients with intrahepatic tumour and showed a longer mOS of 13.9 months (95% CI: 10.6-17.2) over sorafenib with 8.2 months (95% CI: 7.5-9.0), indicating that HAIC-FO may be a more superior option over sorafenib for patients with heavy intrahepatic tumour burden.¹¹

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Disclaimer

This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).