Dr. Kim on the Evolution of Frontline Treatment in HCC

Richard Kim, MD, professor, Moffitt Cancer Center, discusses the evolution of frontline treatment in hepatocellular carcinoma (HCC).

Until recently, the standard first-line treatment for patients with advanced HCC was the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin), based on data from the phase 3 IMbrave150 study (NCT03434379), Kim says. However, other positive data have since read out in this space, according to Kim. One such example is the phase 3 HIMALAYA trial (NCT03298451), which is examining durvalumab (Imfinzi) plus tremelimumab in this population; these data may change the current treatment landscape, Kim explains.

In HIMALAYA, the safety and efficacy of a single priming dose of tremelimumab followed by regular interval durvalumab, also known as the STRIDE regimen, was compared with that of sorafenib (Nexavar) in the first-line setting for patients with advanced HCC, Kim adds. Data showed that those who received the STRIDE regimen experienced a longer overall survival (OS) and progression-free survival than those who were given sorafenib. Three-year follow-up data showed that the 36-month OS rate was 30.7% for patients treated with the STRIDE regimen, Kim says. Although this regimen is not yet approved by the FDA, it is anticipated that approval will be granted in the near future, according to Kim.

Another arm of the trial investigated durvalumab as a single agent compared with sorafenib in this population, Kim adds. Although durvalumab monotherapy did not result in a statistically significant OS improvement vs sorafenib, the benefit derived with the agent appeared to be greater than what has been observed with TKI monotherapy in this setting, Kim notes. Since durvalumab monotherapy proved to be noninferior to sorafenib and to have favorable safety, it could be an alternative option for patients who are not candidates for doublet therapy with dual immunotherapy or immunotherapy plus a VEGF TKI, Kim concludes.