Dr. Singal Discusses Recent Clinical Trials in HCC

Amit G. Singal, MD, associate professor, UT Southwestern Medical Center, discusses recent clinical trials in hepatocellular carcinoma (HCC).

The phase III CELESTIAL trial tested cabozantinib (Cabometyx) versus placebo in the second-line setting for patients with advanced HCC. Interestingly, Singal says, about 25% of the patient cohort had received 2 prior lines of systemic therapy, suggesting that cabozantinib may even be a third-line agent. Data showed that cabozantinib improved survival in the second line compared with placebo.

The REACH-2 trial was informed by a negative phase III study, Singal says. Initially, ramucirumab (Cyramza) was tested versus placebo in the second line for all-comers. In a post-hoc analysis, researchers found there was a potential benefit in patients with a high alpha-fetoprotein (AFP) level. This led to the second trial of ramucirumab versus placebo in patients with high AFP. There was a survival benefit in those patients. This could suggest that AFP is a potential biomarker for the treatment of patients with advanced HCC, Singal says.