Hepatocellular Carcinoma: New Treatment Options and Sequencing Considerations

Laura Kulik, MD


May 15, 2019

Hepatocellular carcinoma is one of the fastest-growing causes of cancer death in the United States. In this ReCAP, Dr Laura Kulik of Northwestern University discusses the recently expanded options for both first- and second-line treatments. A new first-line treatment became available with the approval of lenvatinib in 2018. The drug confers the same overall survival as sorafenib but with a higher response rate, which may prove useful in downstaging patients to resection or possibly transplantation. Dr Kulik also describes the four new agents approved for second-line therapy: regorafenib and cabozantinib, both multikinase inhibitors; and nivolumab and pembrolizumab, two checkpoint inhibitors. All four agents provided survival benefit, though for HCC patients who respond to immunotherapy, the response can be quite durable. Sequencing considerations are discussed, including the recommendation for transplant evaluation of patients prior to administering immunotherapy.


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