Dr. Salem on Locoregional Therapy Versus Systemic Therapy in HCC

Riad Salem, MD, professor of radiology, medicine, and surgery, vice chair, Image Guided Therapy, chief, Vascular Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, discusses the utility of locoregional therapy versus systemic therapy in the treatment of patients with hepatocellular carcinoma (HCC).

The phase III IMbrave150 trial reported a 41% reduction in the risk of disease progression or death with the combination of bevacizumab (Avastin) and atezolizumab (Tecentriq) compared with sorafenib (Nexavar) in patients with newly diagnosed, unresectable HCC (HR, 0.59; 95% CI, 0.47-0.76; P <.0001).

The majority of patients enrolled in IMbrave150 had extrahepatic metastases, says Salem. However, many patients in the real-world setting do not have extrahepatic metastases and may derive greater benefit from localized therapy rather than systemic therapy.

Locoregional therapy offers patients with localized disease a one-time treatment that maintains quality of life, says Salem. Systemic therapy should be considered for patients who progress on or become intolerant of localized therapy.

Among an influx of available treatment options in HCC, understanding how to best select treatment for patients is an ongoing challenge, concludes Salem.