Kabir Mody, MD, an oncology specialist at Mayo Clinic, discusses new directions with yttrium-90 (Y-90) glass microspheres (TheraSphere) in hepatocellular carcinoma (HCC) as demonstrated in the retrospective LEGACY study.

Y-90 glass microspheres are being explored as a neoadjuvant therapy in patients with advanced HCC, according to Mody. The agent holds promise due to its novel delivery method; this has led to different outcomes in terms of tissue and imaging responses, Mody says. These durable responses create more opportunities for patients to receive other therapies that they wouldn’t otherwise be considered for, such as transplant or resection, Mody explains. 

All of this has led to discourse about downstaging patients through embolic therapy, Mody adds. Notably, this is a new development for this modality, and this underscores the progress that has been made with Y-90 in the past 10-15 years, Mody concludes.

Videos

Kabir Mody, MD discusses new directions with yttrium-90 glass microspheres in hepatocellular carcinoma as demonstrated in the retrospective LEGACY study.


Dr. Mody on Progress Made With Y-90 in Hepatocellular Carcinoma

Kabir Mody, MD, an oncologist at Mayo Clinic, discusses the unique approach used to deliver Y-90 glass microspheres (TheraSphere) to patients with unresectable hepatocellular carcinoma (HCC). 

The LEGACY trial examined Y-90 as a bridging therapy for patients with earlier-stage HCC, or as a standalone therapy for those with advanced disease, according to Mody. In the trial, investigators examined the effect of ablative forms of Y-90 in this population.

Y-90 is unique in that it preserves a patient's vasculature and allows for radiation to be delivered in a safe and effective way, Mody explains. The approach yields different outcomes in terms of tissue imaging response, as well as more durable responses; it also allows patients to be considered for therapies they wouldn't otherwise receive, such as transplant or resection, concludes Mody.

Kabir Mody, MD, discusses the unique approach used to deliver Y-90 glass microspheres to patients with unresectable hepatocellular carcinoma. 

Dr. Mody on the Unique Delivery Approach for Y-90 in HCC

Kabir Mody, assistant professor of medicine, consultant, Division of Hematology/Oncology, Mayo Clinic, highlights the recent treatment advances for patients with hepatocellular carcinoma (HCC).

Over the last several years, HCC has risen in incidence in the United States, becoming one of the top causes of cancer death, Mody says. However, there is finally an array of treatment options for these patients. For over a decade, sorafenib (Nexavar) was the only FDA-approved frontline agent, but 2018 brought an explosion of positive trials and regulatory approvals. Mody says researchers need to now use this success as a foundation for the next challenge, which is optimally sequencing these agents.

Another TKI, lenvatinib (Lenvima), was found to be noninferior to sorafenib, which led to its FDA approval for the frontline treatment of patients with advanced disease. Longer follow-up data, however, has suggested a slight advantage in response rate and progression-free survival for lenvatinib. A potentially effective way of sequencing these agents is to look at the etiology of a patient’s underlying liver disease, Mody says, and to assess their risk factors.

In the second-line setting, there is another long list of therapies that are under investigation. Pembrolizumab (Keytruda), nivolumab (Opdivo), ramucirumab (Cyramza), and cabozantinib (Cabometyx) are among the agents that have shown efficacy for patients who progress on a frontline TKI.

Kabir Mody, assistant professor of medicine, consultant, Division of Hematology/Oncology, Mayo Clinic, highlights the recent treatment advances for patients with hepatocellular carcinoma.

Dr. Mody Highlights Treatment Advances in HCC

Kabir Mody, MD, medical oncologist, Mayo Clinic, discusses treatment options for patients with hepatocellular carcinoma (HCC).

For almost a decade, the only treatment approved for patients with HCC was sorafenib (Nexavar). In the last 2 years, multiple options came to the market, including lenvatinib (Lenvima), regorafenib (Stivarga), and nivolumab (Opdivo).

In November 2018, the FDA granted pembrolizumab (Keytruda) an accelerated approval for the treatment of patients with HCC who have previously received sorafenib. This approval was based on findings from the phase II KEYNOTE-224 trial, in which single-agent pembrolizumab induced an overall response rate of 17% among 104 patients with advanced HCC previously treated with sorafenib.

Additionally, the FDA accepted a supplemental new drug application for cabozantinib (Cabometyx) as a treatment for patients with previously-treated advanced HCC in May 2018. In the phase III CELESTIAL trial, cabozantinib improved overall survival by 2.2 months versus placebo. The FDA should have a decision for cabozantinib in this setting by January 14, 2019 based on the Prescription Drug User Fee Act.

Kabir Mody, MD, medical oncologist, Mayo Clinic, discusses treatment options for patients with hepatocellular carcinoma.

Kabir Mody, MD

Articles

Dr. Mody on Progress Made With Y-90 in Hepatocellular Carcinoma

Dr. Mody on the Unique Delivery Approach for Y-90 in HCC

Dr. Mody Highlights Treatment Advances in HCC

Dr. Mody Discusses Treatment Options for HCC