Josep M. Llovet, MD, PhD, founder and director of the Liver Cancer Program, full professor of medicine, Icahn School of Medicine, Mount Sinai Hospital, discusses the potential of combination therapy in hepatocellular carcinoma (HCC).

Combination therapies have been emerging and could represent the future of HCC treatment over the next 3 to 5 years, Llovet says. Recent data have indicated that checkpoint inhibitors are effective for a proportion of patients, about 20% to 30%. These patients achieve durable responses and very good long-term outcomes with immunotherapy. Conversely, this type of therapy has not been relevant for the other 70% to 80% of patients with HCC. Combinations of tyrosine kinase inhibitors, monoclonal antibodies, and checkpoint inhibitors could have an impact, Llovet says.

Findings of a phase Ib study of atezolizumab (Tecentriq) combined with bevacizumab (Avastin) has shown objective response rates of greater than 60%, which is unheard of in advanced HCC. Lenvatinib (Lenvima) plus pembrolizumab (Keytruda) has also shown promise.

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Josep M. Llovet, MD, PhD, founder and director of the Liver Cancer Program, full professor of medicine, Icahn School of Medicine, Mount Sinai Hospital, discusses the potential of combination therapy in hepatocellular carcinoma.

Dr. Llovet on Combination Therapy in HCC

Josep M. Llovet, MD, PhD, founder and director of the Liver Cancer Program, full professor of medicine, Icahn School of Medicine, Mount Sinai Hospital, discusses the potential for biomarkers to improve the treatment of patients with hepatocellular carcinoma (HCC).

Immune checkpoints, such as PD-L1, are expressed in a variety of immune cells, and PD-1/PD-L1 inhibitors designed to block these molecules are proven to be effective against a wide spectrum of malignancies. While checkpoint inhibitors provide a great deal of hope for patients, in the future, it will be key to understand why some patients respond well to these therapies while others do not.

However, it will be equally important to identify biomarkers for patients who have treatment-resistant disease. HCC is subject to an immune-exclusion subclass, in which genetic expression is silent to the immune system. This immune exclusion could one day prove to be a biomarker that can help guide clinical practice in HCC, though this theory will need to be further tested.

View more from the 2018 International Liver Cancer Association Annual Conference 

Josep M. Llovet, MD, PhD, Icahn School of Medicine, discusses the potential for biomarkers to improve the treatment of hepatocellular carcinoma (HCC).

Josep M. Llovet, MD, PhD

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Dr. Llovet on Combination Therapy in HCC

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