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Zanuso V, Rimassa L, Braconi C. The rapidly evolving landscape of HCC: Selecting the optimal systemic therapy. Hepatology 2023:01515467-990000000-00559. [PMID: 37695554 DOI: 10.1097/hep.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023]
Abstract
Over the past years, there has been a remarkable advance in the systemic treatment options for advanced HCC. The overall survival has gradually increased over time, with larger benefits for patients with sensitive tumors and preserved liver function, the latter being an essential condition for the delivery of sequential lines of treatment and optimization of clinical outcomes. With the approval of new first-line agents and the introduction of immune checkpoint inhibitor-based therapies, the treatment landscape of advanced HCC is becoming wider than ever. Atezolizumab plus bevacizumab and, more recently, durvalumab plus tremelimumab have entered the clinical practice and are the current standard of care for treatment-naïve patients, surpassing sorafenib and lenvatinib monopoly. As no head-to-head comparisons are available among all the first-line treatment options, the recommendation for the most appropriate choice and sequence is patient-driven and integrates efficacy data with clinical comorbidities, background liver disease, and the safety profile of available drugs. In addition, predictive biomarkers for successful patients' stratification are yet to be available and constitute the focus of ongoing research. The treatment algorithm is likely to become even more complex since systemic therapeutic approaches are now being translated into earlier stages of the disease, with an impact on the evolution of the sequential treatment of patients with HCC.
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Affiliation(s)
- Valentina Zanuso
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Chiara Braconi
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
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Lopez-Lopez A, Gayoso-Rey M, Garcia-Beloso N, Romero-Ventosa Y, Robles-Torres D, Martinez-Reglero C, Pineiro-Corrales G. Real-world evidence of sorafenib for the treatment of hepatocellular carcinoma: A single-center study. J Cancer Res Ther 2023; 19:1345-1349. [PMID: 37787306 DOI: 10.4103/jcrt.jcrt_308_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Context Hepatocellular carcinoma is the third leading cause of cancer death. Currently, sorafenib is the treatment of choice in advanced hepatocarcinoma. Aims Assessing the effectiveness and toxicity of sorafenib in real-word clinical practice in patients with hepatocarcinoma. Settings and Design Single-centered observational retrospective study. Methods and Material We included patients with hepatocarcinoma who began treatment with sorafenib between 2008 and 2018. We evaluated overall survival, time to progression, and response using RECIST (Response Evaluation Criteria in Solid Tumors) criteria. Toxicity was assessed according to the Common Terminology Criteria for Adverse Events version 5. 2020. Statistical Analysis Used Kaplan-Meier curves and the log-rank test were used to determine the survival time and estimate factors associated with these events. Data were analyzed with SPSS 19.0 software. Results We included 36 patients (88.9% male) with an average age of 64 ± 3.4 years. The tumor stage was advanced (C) in 21 patients (61.8%). We obtained a median overall survival of 8.5 months (IQR 3.14-18.9) and a time to progression of 4.5 months (IQR 2.4-8.8). The main degree of response was progression in 19 patients (36.1%), followed by stable disease in 13 (52.8%). The most commonly reported adverse reactions were: constitutional (83.3%), gastrointestinal (55%) and dermatological symptoms (50.0%). The development of grades 3 or 4 toxicity was not associated with increased overall survival (P = 0.719). Conclusions The findings of the survival analysis obtained in real practice are similar to those obtained in pivotal clinical trials. Adverse reactions were different from those expected.
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Affiliation(s)
- Aida Lopez-Lopez
- Department of Pharmacy, University Hospital Complex of Vigo, Spain
| | | | | | - Yaiza Romero-Ventosa
- Department of Pharmacy, University Hospital Complex of Vigo; NeumoVigo I+i Research Group, Spain
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He P, Wan H, Wan J, Jiang H, Yang Y, Xie K, Wu H. Systemic therapies in hepatocellular carcinoma: Existing and emerging biomarkers for treatment response. Front Oncol 2022; 12:1015527. [PMID: 36483039 PMCID: PMC9723250 DOI: 10.3389/fonc.2022.1015527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/28/2022] [Indexed: 07/21/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy and the third most common cause of cancer-related death worldwide. Due to asymptomatic patients in the early stage, most patients are diagnosed at an advanced stage and lose the opportunity for radical resection. In addition, for patients who underwent procedures with curative intent for early-stage HCC, up to 70% of patients may have disease recurrence within 5 years. With the advent of an increasing number of systemic therapy medications, we now have more options for the treatment of HCC. However, data from clinical studies show that with different combinations of regimens, the objective response rate is approximately 40%, and most patients will not respond to treatment. In this setting, biomarkers for predicting treatment response are of great significance for precise treatment, reducing drug side effects and saving medical resources. In this review, we summarized the existing and emerging biomarkers in the literature, with special emphasis on the pathways and mechanism underlying the prediction value of those biomarkers for systemic treatment response.
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Affiliation(s)
- Penghui He
- Department of Liver Transplant Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Haifeng Wan
- Department of Liver Transplant Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Juan Wan
- Department of Pancreatitis Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Yang
- Department of Abdominal Oncology, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Kunlin Xie
- Department of Liver Transplant Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Wu
- Department of Liver Transplant Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Huang KW, Lee PC, Chao Y, Su CW, Lee IC, Lan KH, Chu CJ, Hung YP, Chen SC, Hou MC, Huang YH. Durable objective response to sorafenib and role of sequential treatment in unresectable hepatocellular carcinoma. Ther Adv Med Oncol 2022; 14:17588359221099401. [PMID: 35646162 PMCID: PMC9134461 DOI: 10.1177/17588359221099401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background The response rate to sorafenib is limited for unresectable hepatocellular carcinoma (HCC). Little is known about the long-term outcomes of objective responders. The role of second-line therapies on the survival of sorafenib-responders is unclear. We aimed to delineate the long-term outcomes and the role of subsequent treatment after responding to sorafenib. Methods From September 2012 to December 2019, 922 patients who received sorafenib treatment for unresectable HCC were retrospectively reviewed. Of these, 21 (2.3%) achieved a complete response (CR) and 54 (5.9%) had a partial response (PR) based on mRECIST criteria. Factors associated with survivals were analyzed. Results During the median follow-up of 35.3 months, the median duration of response was 18.3 months (range: 2.3-45.5) for patients achieving CR and 10.0 months (range: 1.9-60.3) for PR. The median overall survival (OS) was 39.5 months [95% confidence interval (CI): 28.4-50.5] including values not yet estimable for CR and 25.8 months for PR. Patients who experienced treatment-related adverse events (TRAEs) had better median OS than those without (44.9 versus 18.1 months, p = 0.003). Eventually, 53 patients developed tumor progression; 30 patients received second-line systemic treatment including nivolumab (n = 8), regorafenib (n = 15), and chemotherapy (n = 7). Sorafenib-nivolumab sequential therapy provided the best median OS versus sorafenib-regorafenib and sorafenib-chemotherapy in these patients (55.8, 39.5, and 25.5 months), respectively. Conclusions The response is durable for advanced HCC patients with CR or PR to sorafenib. Subsequent immunotherapy seems to provide the best survival. This information is important for characterizing outcomes of sorafenib-responders and the choice of sequential treatment.
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Affiliation(s)
- Kuo-Wei Huang
- Division of Gastroenterology and Hepatology,
Department of Medicine, Taipei Veterans General Hospital, Taipei
- Department of Medicine, Taipei City Hospital
Yang-Ming branch, Taipei
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology,
Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao
Tung University, Taipei
| | - Yee Chao
- Department of Oncology, Taipei Veterans General
Hospital, Taipei
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology,
Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao
Tung University, Taipei
| | - I-Cheng Lee
- Division of Gastroenterology and Hepatology,
Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao
Tung University, Taipei
| | - Keng-Hsin Lan
- Division of Gastroenterology and Hepatology,
Department of Medicine Taipei Veterans General Hospital, Taipei
- Institute of Pharmacology, School of Medicine,
National Yang Ming Chiao Tung University, Taipei
| | - Chi-Jen Chu
- Division of Gastroenterology and Hepatology,
Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao
Tung University, Taipei
| | - Yi-Ping Hung
- Department of Oncology, Taipei Veterans
General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao
Tung University, Taipei
| | - San-Chi Chen
- Institute of Clinical Medicine, School of
Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Oncology, Taipei Veterans
General Hospital, Taipei
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology,
Department of Medicine, Taipei Veterans General Hospital, Taipei
- School of Medicine, National Yang Ming Chiao
Tung University, Taipei
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology,
Department of Medicine, Taipei Veterans General Hospital, Taipei
- Institute of Clinical Medicine, School of
Medicine, National Yang Ming Chiao Tung University, No.201, Sec. 2, Shipai
Road, Beitou District, 11217 Taipei
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Galle PR, Dufour JF, Peck-Radosavljevic M, Trojan J, Vogel A. Systemic therapy of advanced hepatocellular carcinoma. Future Oncol 2020; 17:1237-1251. [PMID: 33307782 DOI: 10.2217/fon-2020-0758] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
For a decade, sorafenib remained the only approved first-line treatment and standard of care for advanced hepatocellular carcinoma. The treatment landscape has been evolving rapidly over the past 2 years with the approval of additional first-and second-line systemic treatments, most of which are targeted therapies. The expected approval of immunotherapies constitutes a paradigm shift: for the first time in years, a checkpoint inhibitor in combination with a VEGF antibody recently outperformed sorafenib with regards to efficacy. The wider availability of systemic therapies increases the chance for longer overall survival but raises new questions concerning the role of local options, treatment choice and sequential treatment. Following an expert discussion at the German Cancer Congress 2020 in Berlin, this article aims to summarize the current evidence on and experience of treatment choice and sequence in first- and second-line therapy.
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Affiliation(s)
- Peter R Galle
- Department of Internal Medicine, University Medical Center Mainz, 55131, Mainz, Rheinland-Pfalz, Germany
| | | | - Markus Peck-Radosavljevic
- Klagenfurt am Wörthersee Hospital, 3 Internal Medicine & Gastroenterology, Hepatology, Endocrinology, Rheumatology & Nephrology, Klagenfurt, Austria
| | - Jörg Trojan
- Hospital of the Goethe University Frankfurt Center of Internal Medicine, Frankfurt am Main, Hessen, Germany
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Tak KY, Nam HC, Choi JY, Yoon SK, Kim CW, Kim HY, Lee SW, Lee HL, Chang UI, Song DS, Yang JM, Kwon JH, Yoo SH, Sung PS, Choi SW, Song MJ, Kim SH, Jang JW. Effectiveness of sorafenib dose modifications on treatment outcome of hepatocellular carcinoma: Analysis in real‐life settings. Int J Cancer 2020; 147:1970-1978. [DOI: 10.1002/ijc.32964] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kwon Yong Tak
- Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine Seoul South Korea
| | - Hee Chul Nam
- Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine Seoul South Korea
| | - Jong Young Choi
- Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine Seoul South Korea
| | - Seung Kew Yoon
- Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine Seoul South Korea
| | | | | | | | - Hae Lim Lee
- Bucheon St. Mary's Hospital Seoul South Korea
| | - U Im Chang
- St. Vincent's Hospital Seoul South Korea
| | | | - Jin Mo Yang
- Incheon St. Mary's Hospital Seoul South Korea
| | | | | | - Pil Soo Sung
- Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine Seoul South Korea
| | | | | | | | - Jeong Won Jang
- Department of Internal MedicineSeoul St. Mary's Hospital, College of Medicine Seoul South Korea
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