Advanced and intermediate HCC: guidance for targeted therapy after first line

  • Lim H & al.
  • J Natl Cancer Inst
  • 8 Sep 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Researchers reviewed the literature on targeted therapies for intermediate and advanced nonlocoregional therapy-eligible hepatocellular carcinoma (HCC) and proposed sequencing principles to guide therapy choice.

Why this matters

  • Phase 3 data are insufficient to guide later lines of treatment.

Study Design

  • Review of 10 phase 3 trials of first-line targeted therapy and 8 phase 3 trials of targeted therapy following sorafenib.
  • Funding: Educational grants from 6 pharmaceutical companies.

Key points

  • First-line therapy:
    • Preferred: atezolizumab plus bevacizumab improved OS and patient-reported outcomes compared with sorafenib and is the preferred therapy.
    • Alternatives: lenvatinib or sorafenib (lenvatinib was noninferior to sorafenib with respect to OS).
  • Second-line therapy:
    • Preferred: lenvatinib or sorafenib.
    • Alternative: cabozantinib or regorafenib (both improved OS in unselected patients), ramucirumab (improved OS in patients with baseline α-fetoprotein ≥400 ng/mL), or atezolizumab plus bevacizumab.
  • Third-line therapy:
    • Preferred: cabozantinib, regorafenib, or ramucirumab.
    • Alternative: discretion of clinician and patient.