Gazala N. Khan, MD, medical oncologist, Henry Ford Health System, discusses the implications of the REFLECT trial in advanced hepatocellular carcinoma (HCC).

The REFLECT trial was a large, randomized, phase III, noninferiority trial looking at lenvatinib (Lenvima) versus sorafenib (Nexavar) in the frontline setting of advanced HCC. The study was positive in that lenvatinib met all of its noninferiority endpoints compared with the standard of care, sorafenib. Specifically, lenvatinib demonstrated a median overall survival (OS) of 13.6 months versus 12.3 months with sorafenib (HR, 0.92; 95% CI, 0.79-1.06).

Based on these data, Khan says lenvatinib is as effective as sorafenib on all fronts. In addition to overall survival, investigators looked at progression-free survival (PFS) and time to progression as secondary endpoints. Similarly, lenvatinib appeared to be superior in PFS, time to progression, as well as response rate, says Khan. As such, the FDA approved the agent in August 2018 for use as frontline therapy in patients with unresectable HCC.

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Dr. Khan on Implications of the REFLECT Trial in HCC

Gazala N. Khan, MD, medical oncologist, Henry Ford Health System, discusses sequencing strategies in advanced hepatocellular carcinoma (HCC).

Given the recent advances in this disease that have led to several FDA-approved agents in the frontline and second-line settings, sequencing is going to be a challenge, Khan says. However, data from the REFLECT study suggest that lenvatinib (Lenvima) is the preferred frontline agent after showing superior response rates and time to progression compared with sorafenib (Nexavar).

In terms of second-line therapy, there are many reasonable options like cabozantinib (Cabometyx) and ramucirumab (Cyramza). Nivolumab (Opdivo) may also be a suitable second-line option, contingent on more mature data. Until more data define the optimal sequence of these drugs, Khan says it should be decided by patient characteristics and preference.

Gazala N. Khan, MD, gastrointestinal medical oncologist, Henry Ford Health System, discusses sequencing strategies in advanced hepatocellular carcinoma.

Gazala N. Khan, MD

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Dr. Khan on Implications of the REFLECT Trial in HCC

Dr. Khan Discusses Sequencing Strategies in Advanced HCC