Andrew X. Zhu, MD, PhD, professor of Medicine, Harvard Medical School, director of Liver Cancer Research, Medicine, Massachusetts General Hospital, discusses the possibility of an optimal second-line treatment for all patients with hepatocellular carcinoma (HCC).

Choosing a second-line treatment in an unselected group of patients is increasing the risk for failure, Zhu explains. However, since researchers do not yet know the true mechanism of action for certain agents, such as regorafenib (Stivarga), it's difficult to determine which subgroup of patients they will demonstrate the most promise in—although regorafenib is associated with an improvement in overall survival.

There are also early, encouraging results with single-agent nivolumab (Opdivo) in HCC, with an approximate 60% response rate in all-comers; however, there is no biomarker yet to determine which patients will benefit most.

This poses a challenge not just in second-line, but across all patients in the frontline setting, Zhu says.

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Andrew X. Zhu, MD

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Dr. Zhu on Optimal Second-Line Treatment for Patients With HCC