Theodore H. Welling MD, associate professor, department of Surgery, director, Liver Tumor Program, NYU Langone’s Perlmutter Cancer Center, discusses the use of selective internal radiation therapy (SIRT) in patients with hepatobiliary cancers.

Physicians are still learning about the full advantages of SIRT. Ablative strategies in general have a role in the treatment of patients with hepatobiliary cancer, says Welling. Physicians are still identifying what combination of modalities, including thermal ablation techniques such as microwave radiofrequency, result in the best ablative approach in conjunction with surgery.

The field is still evolving with respect to highly selective radio embolization for either hepatic metastases or primary liver cancers. There is greater experience with primary liver cancers, states Welling, but physicians are starting to see more tailored approaches for hepatic metastases as well.

Videos

Dr. Welling on SIRT in Patients With Hepatobiliary Neoplasms

Theodore H. Welling, MD, associate professor of surgery, director of the Liver Tumor Program at NYU Langone Health's Perlmutter Cancer Center, discusses the efficacy of nivolumab (Opdivo) for patients with hepatocellular carcinoma (HCC).

The initial findings of CheckMate-040 show that nivolumab was well tolerated and safe. The toxicity profile is better than what is seen currently with other agents, explains Welling. There have been significant responses seen with all subsets of patients.

There have been durable responses, states Welling. The data are still being analyzed to determine what the overall survival will be with the cohorts. Ongoing studies are being conducted to compare nivolumab with other agents.

Theodore H. Welling, MD, associate professor of surgery, director of the Liver Tumor Program at Perlmutter Cancer Center of NYU Langone Medical Center, discusses the efficacy of nivolumab (Opdivo) for patients with hepatocellular carcinoma (HCC).

Dr. Welling on the Efficacy of Nivolumab in HCC

Theodore H. Welling, MD, associate professor of surgery, director of the Liver Tumor Program at Perlmutter Cancer Center of NYU Langone Medical Center, discusses the purpose of the CheckMate-040 trial, which explored nivolumab (Opdivo) in patients with hepatocellular carcinoma. (HCC).

The phase I/II trial demonstrated the safety and efficacy findings of nivolumab in patients who were previously exposed to sorafenib (Nexavar) and failed or ultimately progressed on sorafenib versus patients who were naïve to sorafenib, Welling explains. Currently, sorafenib is the only medicine approved for the frontline treatment of patients with HCC.

The anti—PD-1 inhibitor nivolumab is designed to block the PD-1 pathway, allowing the immune system theoretically to increase its response&mdash;or at least have a return of response&mdash;in what could otherwise be exhausted immune cells, Welling adds.

Dr. Welling on CheckMate-040 Trial of Nivolumab in HCC

Theodore H. Welling, MD, associate professor of surgery, director of the Liver Tumor Program at Perlmutter Cancer Center of NYU Langone Medical Center, discusses how immunotherapy agents will eventually fit into the paradigm of hepatocellular carcinoma. (HCC).

How immunotherapy fits is going to be a major area of research, Welling explains. There are a lot of caveats and permutations, which makes the therapy potentially exciting, he adds.

Additionally, optimally incorporating immunotherapy will include combining and further characterizing which patients are most likely to respond to immuno-oncology therapy. There are other agents that block or accelerate other pathways of the immune response, Welling says. Therefore, combining this type of therapy with other agents that block either other co-inhibitory pathways or combining with other agents that maybe accelerate other pathways of the immune response is another area of research. 

Theodore H. Welling MD

Articles

Dr. Welling on SIRT in Patients With Hepatobiliary Neoplasms

Dr. Welling on the Efficacy of Nivolumab in HCC

Dr. Welling on CheckMate-040 Trial of Nivolumab in HCC

Dr. Welling on Incorporating Immunotherapy Into HCC Paradigm