ASCO Guidelines for the Use of Systemic Therapies in Advanced Hepatocellular Cancer

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CARDIOVASCULAR DISEASE

Medical writer: Kirsty LEE | Last updated: 7 December 2020 | In: Gastrointestinal Cancer, Lung Cancer, Oncology, Immunotherapy, Guidelines, Targeted Therapies

Article Keywords

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Hepatocellular carcinoma (HCC) accounts for 80% of all liver cancers, and 55% of all HCC cases worldwide are reported from China.¹ In Hong Kong, liver cancer is the fourth most common cancer and the third most common cause of cancer death.¹ Clinical advancements over past decade has led to a number of systemic therapies introduced for the treatment of HCC.² The American Society of Clinical Oncology (ASCO) recently released guidelines for the use of systemic therapies in treating advanced HCC.²

The ASCO guidelines had the following, notable changes.

The results of the IMbrave 150 phase III randomised controlled trial (RCT) with atezolizumab plus bevacizumab vs sorafenib showed overall survival (OS) superiority over sorafenib.² Atezolizumab in combination with bevacizumab is now recommended by ASCO as a first-line option for advanced HCC patients with Child-Pugh class A status, and an ECOG PS of 0-1, following the management of oesophageal varices when present.²

In patients with contraindications to atezolizumab or bevacizumab, sorafenib or lenvatinib may be offered as the first-line treatment for patients with advanced HCC, Child-Pugh class A status, and ECOG PS 0-1.² However, treatment with these recommended TKIs may be less effective for patients with more advanced cirrhosis.²

For second-line treatment options after immunotherapy, tyrosine kinase inhibitors (TKIs) such as sorafenib, lenvatinib, cabozantinib, or regorafenib may be used.² However, following first-line therapy with a TKI, e.g. sorafenib or lenvatinib, the recommended second-line includes cabozantinib, ramucirumab (for patients with α-fetoprotein ≥ 400 ng/mL), regorafenib (for patients who tolerated sorafenib well), or atezolizumab + bevacizumab.² Immune checkpoint inhibitors such as pembrolizumab or nivolumab may be considered as second-line options in patients with contraindications to – or unable to tolerate – TKIs.²

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Reference

Zhu RX et al. Gut Liver. 2016;10(3):332-339

Gordan JD et al. J Clin Oncol. Published online November 16, 2020:JCO.20.02672.

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).