Dr Franses on Considerations for Second-Line Treatment of HCC

Joseph Franses, MD, PhD, assistant professor of medicine, at the University of Chicago Medicine Comprehensive Cancer Center, discusses the considerations for treatment in patients with unresectable or advanced hepatocellular carcinoma (HCC) whose disease progresses after first-line therapy.

Following disease progression on a first-line regimen, a proportion of patients with advanced HCC remain fit enough to pursue additional treatment options, according to Franses. In the absence of prospective clinical trials providing head-to-head comparisons of potential second-line regimens, clinicians are able to utilize various regimens to tailor subsequent therapies based on the patient's response and tolerance to previous treatment, he continues.

Although combination regimens such as atezolizumab (Tecentriq) plus bevacizumab (Avastin) and tremelimumab-actl (Imjudo) plus durvalumab (Imfinzi) have been approved by the FDA for use in the frontline setting for patients with unresectable HCC, off-label use in the second-line setting could be considered, allowing for the potential sequencing of these options if a dose-limiting toxicity is not observed, Franses says. Lenvatinib (Lenvima) monotherapy is also commonly used to treat HCC in the second-line setting, he adds. The combination of nivolumab (Opdivo) and ipilimumab (Yervoy) also received prior FDA approval for the treatment of unresectable HCC after treatment with sorafenib (Nexavar).

Notably, the National Comprehensive Cancer Network Guidelines also list single-agent cabozantinib (Cabometyx), regorafenib (Stivarga), or sorafenib as treatment options for subsequent lines of therapy following disease progression. Nivolumab plus ipilimumab, as well as single-agent pembrolizumab (Keytruda), are also listed under other recommended regimens.

Although there are some treatment options to consider in the second-line setting for patients with unresectable HCC, more prospective data are needed to assess potential options and better inform decision-making for patients whose disease progresses following first-line therapy, Franses concludes.