Dr. Abou-Alfa on Sequencing Agents in the Treatment of Patients With HCC

Ghassan K. Abou-Alfa, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses how the potential approval of cabozantinib (Cabometyx) in hepatocellular carcinoma (HCC) could affect the treatment landscape in liver cancer.

Sequencing drugs is never simple, and the approval of new agents forces physicians to reassess patients’ treatment lineups. Findings from the phase III CELESTIAL trial, presented at the 2018

Gastrointestinal Cancers Symposium (GICS), show that treatment with cabozantinib results in improved outcomes in patients with advanced HCC.

Frontline and second-line treatment is not only dependent on cabozantinib data but also on that of nivolumab. If the CheckMate-459 study and HIMALAYA studies, the second of which is examining the combination of anti—PD-1 plus anti–CTLA-4, are positive, patients should expect to receive checkpoint inhibitors as a first-line therapy and tyrosine-kinase inhibitors (TKIs) as a second-line treatment.