Which choice of therapy when many are available? Current systemic therapies for advanced hepatocellular carcinoma

Personeni, Nicola; Pressiani, Tiziana; Rimassa, Lorenza

doi:10.1002/hsr2.147

Cited by 3 publications

(3 citation statements)

References 38 publications

(62 reference statements)

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“…10 Moreover, strategies combining a human cytotoxic T-lymphocyte antigen 4 (CTLA-4)blocking antibody plus an anti-PD-1 antibody have been approved in patients previously treated with sorafenib. 11 Despite the unprecedented wealth of systemic treatment options now available, 12 there exist special populations for whom, paradoxically, no treatment can be recommended because of a lack of clinical information for their specific conditions. Historically, these patients represent an unmet medical need.…”

Section: Introductionmentioning

confidence: 99%

Systemic treatment of HCC in special populations

Rimassa

Personeni

Czauderna

et al. 2021

Journal of Hepatology

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Recent years have seen significant progress in the systemic treatment of hepatocellular carcinoma (HCC), including the advent of immunotherapy. While several large phase III trials have provided the evidence for a multi-line treatment paradigm, they have focused on a highly selected group of patients by excluding potentially confounding comorbidities. As a result, high quality evidence for the systemic treatment of HCC in patients with various comorbidities is missing. This review summarises current knowledge on the use of approved medicines in patients with HIV, autoimmune disease, cardiovascular disease, diabetes, fibrolamellar HCC, mixed HCC-cholangiocarcinoma, decompensated cirrhosis (Child-Pugh B and C), a significant bleeding history, vascular invasion or portal vein thrombosis, as well as the elderly, those on haemodialysis, and those after solid organ transplantation. The article highlights relevant knowledge gaps and current clinical challenges. To improve the safety and efficacy of HCC treatment in these subgroups, future trials should be designed to specifically include patients with comorbidities.

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Section: Introductionmentioning

confidence: 99%

Systemic treatment of HCC in special populations

Rimassa

Personeni

Czauderna

et al. 2021

Journal of Hepatology

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“…Finally, there is a great uncertainty about the most appropriate second-line option [80,81]: in particular, after the combination of atezolizumab-bevacizumab, no data-driven sequencing strategy was developed, and all available second-line strategies were tested after sorafenib discontinuation (Fig. 1).…”

Section: Future Perspectivesmentioning

confidence: 99%

The evolving treatment paradigm of advanced hepatocellular carcinoma: putting all the pieces back together

D’Alessio

Cammarota

Prete

et al. 2021

Current Opinion in Oncology

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Purpose of reviewThe therapeutic landscape of advanced hepatocellular carcinoma (HCC) has become notably complex in recent years. With this review, we aimed to put the most recent findings in perspective and tried to delineate the rapidly changing treatment algorithm. Recent findingsThe combination of atezolizumab and bevacizumab has become the new first-line standard of care treatment for unresectable HCC after the positive results of the phase 3 IMbrave150 study. Nivolumab monotherapy failed to demonstrate advantage versus sorafenib in the CheckMate 459 trial, while two different therapeutic strategies (sintilimab and bevacizumab biosimilar and donafenib) outperformed sorafenib in two phase 2/3 studies conducted in the Chinese population. Several immunotherapy combinations are currently under study in large phase 3 trials after promising results in earlier phase studies. About further lines of treatment, the combination of ipilimumab and nivolumab was approved for sorafenib-pretreated patients after the positive results of the phase 1/2 CheckMate 040 study and apatinib was proven effective in the Chinese population in a phase 2/3 study, while pembrolizumab as monotherapy did not show statistically significant superiority when compared with placebo in the KEYNOTE-240 study.

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“…In this rapidly evolving scenario, it is extremely important that physicians are updated and aware of novel therapeutic options in order to make the best use of them in various clinical settings [ 19 , 20 ].…”

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confidence: 99%