Potential Impact of IMbrave150 Results in the Evolving Treatment Landscape of Advanced Hepatocellular Carcinoma: A Multidisciplinary Expert Opinion

Abstract

A virtual expert roundtable was convened on April 16, 2020, to discuss the evolving landscape of care for treating patients with advanced hepatocellular carcinoma (HCC) and discuss questions related to patient care and treatment selection. This commentary presents highlights from this discussion and provides an expert opinion about approaches to treatment for HCC in the Americas and the European Union. We anticipate that atezolizumab plus bevacizumab will become the standard of care for advanced HCC patients. However, this approach will make decisions regarding the sequencing of treatments for second-line therapies and beyond more challenging. Therapy will require individualization based on patient characteristics and preferences, while insurance coverage decisions and requirements may also impact the options that patients can access. Additional research regarding prognostic and predictive biomarkers is needed to help better identify optimal treatment approaches for specific patient populations. Multidisciplinary tumor boards will continue to play a critical role in guiding treatment selection for individual patients. Atezolizumab plus bevacizumab offers a promising new first-line therapeutic option for patients with advanced HCC, but more research is needed to optimize and individualize patient therapy.

Dynamics in Circulating Proinflammatory Biomarkers for Prognostic Assessment of Patients With Advanced HCC – A Substudy From the SORAMIC Trial

“…Baseline concentrations of IL-6 and IL-8 have been demonstrated to be predictive for response to sorafenib monotherapy in patients with advanced HCC (5). Recently, the combination of atezolizumab, a humanized anti-PDL1 antibody to restore antitumor T-cell activity, with bevacizumab, binding to VEGF, has been defined as the new first line treatment standard (29,30).…”

Current Status of Management of Hepatocellular Carcinoma in The Gulf Region: Challenges and Recommendations

“…The combination of atezolizumab and bevacizumab was the first regimen to improve OS compared with sorafenib [ 68 , 93 , 101 , 102 ]. However, bevacizumab, an extensively characterized anti-angiogenic agent used for multiple cancer indications, may increase the risk of hemorrhage, particularly in patients with HCC who are already vulnerable to hemorrhagic events [ 79 , 89 , 106 ]. Analysis of safety data from the IMbrave150 trial showed that AEs of particular relevance to atezolizumab (hepatitis, rash, hypothyroidism, infusion-related reaction, hyperthyroidism, pancreatitis, and T2D) occurred in 68.7% of patients receiving atezolizumab plus bevacizumab and in 82.1% of patients receiving sorafenib [ 68 ].…”

“…Analysis of safety data from the IMbrave150 trial showed that AEs of particular relevance to atezolizumab (hepatitis, rash, hypothyroidism, infusion-related reaction, hyperthyroidism, pancreatitis, and T2D) occurred in 68.7% of patients receiving atezolizumab plus bevacizumab and in 82.1% of patients receiving sorafenib [ 68 ]. AEs of particular relevance to bevacizumab, including hemorrhagic events, venous or arterial thromboembolic events, hypertension, and proteinuria, occurred in 57.8% of patients receiving atezolizumab plus bevacizumab and in 48.7% of patients receiving sorafenib [ 66 , 89 , 106 ]. Clinically significant portal hypertension associated with a high risk of gastro-esophageal varices is common in patients with HCC and was present in 42% of patients with Child-Pugh A and 72% of patients with Child-Pugh B or C liver function [ 90 ].…”

Efficacy and safety of immune checkpoint inhibitors-combined antiangiogenic drugs in the treatment of hepatocellular carcinoma: A systematic review and meta analysis

“…The effect of immunologic drug monotherapy for unresectable HCC is unsatisfactory, and the ORR of PD-1 monotherapy for HCC is 17%-20%. But so far, the survival superiority of monotherapy with ICIs including PD-1 has not been demonstrated in randomized studies ( 9 ).…”

“…Although these drugs have a certain degree of survival benefit, they are accompanied by considerable toxicity. According to RECIST1.1, the objective response rate (ORR) of lenvatinib and sorafenib for unresectable HCC was 19% and 7%, respectively ( 9 ).…”