Dr. Bekaii-Saab on Improved Sequencing Strategies in HCC

Tanios S. Bekaii-Saab, MD, FACP, medical oncologist, medical director, Cancer Clinical Research Office, vice chair and section chief, Medical Oncology, Department of Internal Medicine, Mayo Clinic, discusses improved sequencing strategies in hepatocellular carcinoma (HCC).

The combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) has been solidified as the standard first-line treatment option for eligible patients with advanced HCC, says Bekaii-Saab. Notably, the May 2020 regulatory approval of the combination for the treatment of patients with unresectable or metastatic HCC who have not received prior systemic therapy ​allowed this regimen to replace traditional frontline options, such as sorafenib (Nexavar) and lenvatinib (Lenvima), ​Bekaii-Saab explains.

Historically, ​limited treatment options were available for patients with HCC​, says Bekaii-Saab. However, with the influx of novel therapies, ongoing research efforts are trying to establish optimal sequencing with second- and third-line therapies. Currently, second-line options include regorafenib (Stivarga) and cabozantinib (Cabometyx). ​These agents can also be used in the third-line setting, along with the option of ipilimumab (Yervoy) and nivolumab (Opdivo) ​for patients who did not receive a TKI in the second-line setting, says Bekaii-Saab.

 ​Improved sequencing strategies with novel agents ​have led to a significant increase in overall survival (OS) ​for patients with advanced HCC ​in 2020 compared with 2007. In 2007, the ​median OS was around 7 to 8 months​. Now, the ​median OS is over 2 years, Bekaii-Saab concludes.