Evidence-based clinical practice guidelines to identify the preferred treatment options for first-line and subsequent systemic therapy for advanced hepatocellular carcinoma (HCC) were developed and presented in a recent study published in the Journal of Clinical Oncology (2020. doi:10.1200/JCO.20.02672).
“This guideline incorporates the evidence for systemic therapy options for patients with advanced HCC to provide recommendations to clinicians who are treating patients within the target population,” explained John Gordan, MD, PhD, University of California, San Francisco, (San Francisco, CA) and colleagues.
An ASCO Expert Panel conducted a systematic review of published phase 3 randomized controlled trials between January 1, 2007 and May 15, 2020 on systemic therapy for advanced HCC. Clinical practice guidelines and recommended care options for this patient population were developed.
The guideline provides recommendations for therapies for first-, second-, and third-line settings.
In the first-line, atezolizumab-bevacizumab can be given to most patients with advanced HCC, Child-Pugh class A, ECOG PS 0-1, and following management of esophageal varices, when present, according to institutional guidelines. If contraindications to atezolizumab and/or bevacizumab are present, sorafenib and lenvatinib may be offered.
In the second-line, therapy options have only been evaluated following sorafenib. The Expert Panel agrees that these data may be extended to the use of lenvatinib in the second-line since they are both tyrosine kinase inhibitors (TKIs). In addition to sorafenib and lenvatinib, options for second-line therapy include regorafenib, cabozantinib, and ramucirumab.
In the third-line, cabozantinib is approved for patients with advanced HCC.
Emerging data on the combination of TKIs and immune checkpoint inhibitors will inform the role and application of these treatments in the future. In addition, there is still a need for genetic and/or IHC biomarkers to guide decision making.
“Multidisciplinary management of the patient with HCC in an environment that fosters dialogue, continuing education, and guideline-driven consensus among stakeholders is key to optimizing patient outcomes,” explained Dr Gordan and colleagues.—Lisa Kuhns