Dr Pedersen on the Evolution of Immunotherapy in HCC

Katrina S. Pedersen, MD, MS, associate professor, Department of Medicine, Division of Oncology, Section of Medical Oncology, Washington University School of Medicine, Siteman Cancer Center, discusses the evolution of the role ofimmunotherapy in the treatment of patients with hepatocellular carcinoma (HCC).

The integration of immunotherapy into the management of HCC marks a significant milestone, substantially altering the potential clinical outcomes for patients with unresectable HCC, Pedersen begins. Notably, 2 pivotal phase 3 trials have emerged, each contributing crucial insights into the efficacy of immunotherapeutic approaches, she explains. The IMbrave150 trial (NCT03434379) investigated the combination of atezolizumab (Tecentriq) and bevacizumab (Avastin) in patients with treatment-naive systemic HCC. The HIMALAYA trial (NCT03298451), explored the STRIDE (Single Tremelimumab Regular Interval Durvalumab) regimen, involving durvalumab (Imfinzi) with a priming dose of tremelimumab (Imjudo) followed by durvalumab maintenance therapy, Pedersen emphasizes.

Real-world observations with the IMbrave150 and STRIDE regimens indicate that although their real-world clinical benefits may not uniformly mirror those reported in trials, a discernible shift in the tolerability, progression-free survival (PFS), and overall survival (OS) outcomes among North American patients with HCC is evident since the introduction of these treatment options, she expands. Notably, comparative analyses between immunotherapy combinations and those incorporating VEGF-targeting agents, such as bevacizumab, have not yet been conducted, necessitating a deeper understanding of the optimal treatment strategies for patients with HCC, Pedersen states.

Clinical decision-making regarding agent selection leans heavily on individual patient profiles and clinical parameters, Pedersen continues. Nonetheless, tangible real-world benefits have been observed with both regimens, underscoring the promise of these advancements, she reports. Furthermore, the ongoing evolution of treatment approaches extends beyond mere drug combinations, delving into the integration of immunotherapy with diverse liver-directed therapies, Pedersen notes, adding that this interdisciplinary treatment approach encompasses modalities such as transarterial chemoembolization, various ablations, external beam radiation, and in select cases, resection.

As the field progresses toward next-generation combinations, the convergence of targeted therapies with immunomodulation heralds a promising era in HCC management, emphasizing the importance of interdisciplinary collaboration and personalized medicine in optimizing patient outcomes, Pedersen concludes.