R. Kate Kelley, MD, associate professor of clinical medicine, Department of Medicine, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses the clinical impact of REFLECT and CELESTIAL in hepatocellular carcinoma (HCC).

After the approval of sorafenib (Nexavar), there was a string of negative trials in HCC. Last year, 4 other HCC agents were reported in positive trials. In 2017, 2 drugs were approved in addition to sorafenib. Regorafenib (Stivarga) was approved as a second-line agent, and nivolumab (Opdivo) was approved after first-line sorafenib.

In early 2018, the REFLECT and CELESTIAL trials reported positive findings. REFLECT examined the use of frontline lenvatinib (Lenvima) and showed noninferiority to sorafenib. At the 2018 Gastrointestinal Cancers Symposium, CELESTIAL reported a benefit in the use of second- or third-line cabozantinib (Cabometyx) following sorafenib. All of a sudden, Kelley says, physicians have to navigate a very complex landscape.

Now, the wildcard is nivolumab, which has the potential to change the landscape even further.

R. Kate Kelley

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Dr. Kelley on Newly Approved Agents in HCC