Dr. Finn Discusses Sequencing Therapy for HCC

Richard S. Finn, MD, assistant professor of medicine, Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine, University of California, Los Angeles, discusses sequencing therapy for patients with hepatocellular carcinoma (HCC).

The last 1.5 years has brought about multiple positive phase III data regarding treatment for patients with HCC, says Finn. If these drugs are approved, the next step is figuring out how to optimally sequence therapy with other recently approved agents like regorafenib (Stivarga) and nivolumab (Opdivo). There is currently no high-level data to advise how to sequence.

Finn says that advanced HCC occurs in the setting of advanced cirrhosis, so it is important to identify patients appropriately to optimize their sequencing. In the past, when few drugs were available, patients would receive locoregional therapy beyond what was suggested, says Finn. This continued to occur with sorafenib (Nexavar), and patients were not transitioned to systemic treatment at an appropriate time. Finn says that patients should be transitioned when they have radiographic progression, not clinical progression or decompensation. This is more important now with these new drugs available, because if a patient is too ill from their underlying cirrhosis, then getting them to the second- and third-line will be difficult or impossible.