Targeted therapy or immunotherapy? Optimal treatment in hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer mortality in the United States and the second leading cause of cancer mortality worldwide. Sorafenib is the only food and drug administration (FDA) approved as first line systemic treatment in HCC. Regorafenib and nivolumab are the only FDA approved second line treatment after progression on sorafenib. We will discuss all potential first and second line options in HCC. In addition, we also will explore sequencing treatment options in HCC, and examine biomarkers that can potentially predict benefits from treatments such as immune checkpoint inhibitor. This minireview summarizes potential treatments in HCC based on clinical trials that have been published in manuscript or abstract format from 1994-2018.

Management and Treatment of Hepatocellular Carcinoma with Immunotherapy: A Review of Current and Future Options

“…34 There are also currently other ongoing trials investigating nivolumab as a single agent in CheckMate-9DX and also in combination with ipilimumab for previously-treated patients with HCC. 26,35,36 Pembrolizumab While nivolumab was investigated as a first-line treatment option for HCC, another anti-PD-1 antibody, pembrolizumab, is being developed as a second-line treatment after initial treatment with tyrosine kinase inhibitors have failed or were not tolerable. 27 In a phase II trial, patients with advanced liver cancer who were sorafenib-refractory, sorafenib-intolerant, or sorafenib-naïve received one standard dose of pembrolizumab.…”

“…34 There are also currently other ongoing trials investigating nivolumab as a single agent in CheckMate-9DX and also in combination with ipilimumab for previously-treated patients with HCC. 26 , 35 , 36 …”

High KIAA1522 expression predicts a poor prognosis in patients with hepatocellular carcinoma

“…This is due to high recurrence and metastasis, which are the predominant causes of mortality in patients with HCC (9). Regarding patients with severe early disease who undergo liver resection or liver transplantation, >80% exhibit recurrence following surgery, which affects their quality of life (10). A number of factors have predictive prognostic value for HCC, including tumor size, tumor differentiation, vascular invasion, marginal resection, and novel immunological and tissue biomarkers (11)(12)(13)(14)(15).…”

Ter‐cell, A New Target for Hepatocellular Carcinoma Therapy

“…Regorafenib is a small-molecule kinase inhibitor of the angiogenic, stromal,a nd oncogenic cellular processes and pathways. [12] Its therapeutic effect in the clinici se lusive, but its potential toi nhibitt he artemin-targetedr eceptor RET to inhibito ncogenesis of HCC has been prospected. To sum up, more effective medicines for HCC treatment are urgently needed.…”

“…Two other drugs, also proven by the FDA for HCC in 2017, are regorafenib and nivolumab. Regorafenib is a small‐molecule kinase inhibitor of the angiogenic, stromal, and oncogenic cellular processes and pathways . Its therapeutic effect in the clinic is elusive, but its potential to inhibit the artemin‐targeted receptor RET to inhibit oncogenesis of HCC has been prospected.…”