Ryan W. Huey, MD, an assistant professor within the Department of Gastrointestinal Medical Oncology at The University of Texas MD Anderson Cancer Center, discusses challenges faced with immunotherapy in hepatocellular carcinoma (HCC).

The field of HCC has learned that patient selection is going to be very important moving forward, says Huey, not just in terms of the groups of patients that are being targeted. It is also worth remembering that not all disease is created equal, says Huey. There may be more of a signal with immunotherapy in the early stages of disease, potentially evenresectable disease, whereas patients whose disease has progressed further and have deteriorated liver functionmay not have as much susceptibility to these agents.

The answer to this question is still open, says Huey. The answer might be that immunotherapy by itself is not sufficient and investigators need to find a better way to harness that. An additional challenge faced in the HCC space, is a lack of tissue. As such, the opportunity to find predictive biomarkers is less than it would be in other tumor types, explains Huey. While some biomarkers in other diseases leave oncologists wanting for a bit more, they can help provide a signal for the rationale for immunotherapy, which is something that is not available in HCC, concludes Huey.

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Ryan W. Huey, MD, discusses challenges faced with immunotherapy in hepatocellular carcinoma.

Dr. Huey on Challenges Faced With Immunotherapy in HCC

Ryan W. Huey, MD, assistant professor, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, discusses the landscape of hepatocellular carcinoma (HCC).

Over the past several years, there has been a dramatic increase in the number of systemic therapies that are available to patients with HCC, says Huey. Previously, sorafenib (Nexavar) was the only major player in the space. Now, there are a number of drugs that are approved for use in the frontline and second-line settings, including lenvatinib (Lenvima) and nivolumab (Opdivo)/ipilimumab (Yervoy), respectively.

Additionally, health-related quality-of-life data are coming out, says Huey. Even so, sequencing is becoming increasingly complex. Optimal sequencing strategies have yet to be determined since many second-line treatments are contingent on sorafenib’s use in the frontline setting. However, real-world data sets could shed light on sequencing strategies for patients who receive lenvatinib or the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) in the frontline setting, concludes Huey.

Dr. Huey on Navigating the Landscape of HCC

Ryan W. Huey, MD, assistant professor, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, discusses potential sequencing options with sorafenib (Nexavar) among novel combination strategies in hepatocellular carcinoma (HCC).

Sorafenib continues to be a first-line standard of care for patients with advanced HCC.

In January 2020, a supplemental biologics license application was submitted to the FDA for the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) for the treatment of patients with unresectable HCC who have not received prior systemic therapy. If the combination is approved, it could replace sorafenib as the frontline standard of care for patients with advanced disease, says Huey.

While there are little data regarding sorafenib’s use in the second-line setting in this patient population, the agent is expected to remain part of the armamentarium as physicians are familiar with its utility, explains Huey.

Further analysis is needed to determine whether the biologic rationale for utilizing TKIs after VEGF inhibitors is clinically sound, concludes Huey.

Ryan W. Huey, MD, discusses potential sequencing options with sorafenib among novel combination strategies in hepatocellular carcinoma.

Ryan W. Huey, MD

Articles

Dr. Huey on Challenges Faced With Immunotherapy in HCC

Dr. Huey on Navigating the Landscape of HCC

Dr. Huey on Sequencing Sorafenib Among Novel Combos in HCC