Jimmy Hwang, MD, medical oncologist, Levine Cancer Institute, Atrium Health, discusses the current state of available first-line treatment options in hepatocellular carcinoma (HCC), and areas of continued unmet need in this space.

Patients who have HCC with preserved hepatic function have several first-line treatment options in clinical practice, Hwang begins. When considering agents being evaluated in current clinical trials, thetreatment armamentarium appears set to expand even further, he says. Previous data has shown that the use of immunotherapy alone or in combination provides greater patient benefit when compared with previous standard-of-care (SOC) TKIs like sorafenib (Nexavar) or lenvatinib (Lenvima), Hwang expands. 

Both immuno-oncology (IO)/IO combinations or IO plus VEGF TKI regimens have elicited high survival outcomes and patient responses, as well as favorable toxicity profiles, he explains. The combination of atezolizumab (Tecentriq) plus bevacizumab (Avastin) has shown considerable efficacy for patients with HCC in the frontline setting. Since its FDA approval on May 29, 2020, the regimen has become a category 1 recommendation in the National Comprehensive Cancer Network guidelines, and a SOC treatment in this space. 

Immunotherapy regimens are effective options for patients with HCC with preserved hepatic function, Hwang continues. However, the greatest challenge in HCC remains the identification of viable and effective treatment alternatives for patients who do not meet specific eligibility criteria in clinical trials, Hwang notes. There is currently a lack of definitive data on the tolerability and safety of immunotherapy and an overall need for more clarity when determining a treatment approach in this population, Hwang emphasizes. 

It is especially important to address this challenge through future research, as these patients comprise a significant proportion of the overall population in HCC, Hwang concludes.

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Jimmy Hwang, MD, discusses currently available first-line treatment options in hepatocellular carcinoma, and areas of continued unmet need in this space.

Dr. Hwang on First-line Treatment Options in HCC

Jimmy Hwang, MD, medical oncologist, Levine Cancer Institute, Atrium Health, discusses considerations for second-line treatment in gastric/gastroesophageal junction (GEJ) cancer.

Treatment selection in the second-line setting for patients with gastric/GEJ cancer depends largely on what was given in the first-line setting, says Hwang. It is unknown whether checkpoint inhibitors can be continued into the second-line setting in gastric/GEJ cancer if they were administered up front, such as with trastuzumab (Herceptin) in HER2-positive breast cancer or bevacizumab (Avastin) in colorectal cancer, Hwang explains. 

Treatment selection is difficult in the second-line setting for this patient population because it is a largely data-free landscape. Hwang says. However, on January 15, 2021, the FDA approval fam-trastuzumab deruxtecan-nxki (Enhertu) for the treatment of adult patients with locally advanced or metastatic HER2-positive gastric/GEJ adenocarcinoma who have received a previous trastuzumab-based regimen. Patients with HER2-positive disease who receive pembrolizumab (Keytruda), chemotherapy, and trastuzumab in the frontline setting are eligible for trastuzumab deruxtecan in the second-line setting, but there are no data to inform how patients who received up-front pembrolizumab will fare with the antibody-drug conjugate, concludes Hwang.

Jimmy Hwang, MD, discusses considerations for second-line treatment in gastric/gastroesophageal junction cancer.  



Jimmy Hwang, MD

Articles

Dr. Hwang on First-line Treatment Options in HCC

Dr. Hwang on Considerations for Second-Line Treatment in Gastric/GEJ Cancer