Cargando…
Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma
Sorafenib and lenvatinib are approved for first‐line treatment of patients with advanced hepatocellular carcinoma (HCC), and the efficacy of atezolizumab plus bevacizumab has been demonstrated versus sorafenib. Over time, first‐line treatment frequently fails, and regorafenib, cabozantinib, ramuciru...
Autores principales: | , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496898/ https://www.ncbi.nlm.nih.gov/pubmed/32432830 http://dx.doi.org/10.1111/liv.14533 |
_version_ | 1783583200202719232 |
---|---|
author | Rimassa, Lorenza Wörns, Marcus‐Alexander |
author_facet | Rimassa, Lorenza Wörns, Marcus‐Alexander |
author_sort | Rimassa, Lorenza |
collection | PubMed |
description | Sorafenib and lenvatinib are approved for first‐line treatment of patients with advanced hepatocellular carcinoma (HCC), and the efficacy of atezolizumab plus bevacizumab has been demonstrated versus sorafenib. Over time, first‐line treatment frequently fails, and regorafenib, cabozantinib, ramucirumab (for patients with alpha fetoprotein ≥400 ng/mL), nivolumab, pembrolizumab and ipilimumab plus nivolumab are approved for use after sorafenib (but not lenvatinib) treatment in advanced HCC. Given the considerable complexity in the therapeutic landscape, the objective of this review was to summarize the clinical evidence for second‐line agents and provide practical guidance for selecting the best sequential treatment approach. The timing and sequencing of treatment switches are key to optimizing patient outcomes in advanced HCC, and decisions should be informed by reasons for discontinuation of previous therapy and disease progression. It is important not to switch too soon, because sequential treatment benefit may then be lost, nor should switching be delayed too long. Effectiveness, safety and tolerability, patient quality of life, route of administration, dosing regimen, drug class, molecular target and individual patients’ characteristics, including comorbidities, inform the selection of second‐line systemic treatment, independently of the aetiology of HCC, tumour stage and the response to previous treatment. Biomarkers predictive of treatment effectiveness are of great value, but currently biomarker‐driven patient selection is possible only in the case of ramucirumab. The approval of new combination therapies for advanced HCC in the first‐line setting will further increase the complexity of decision‐making. However, the important factors will remain the individual patient’s characteristics and preferences. |
format | Online Article Text |
id | pubmed-7496898 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74968982020-09-25 Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma Rimassa, Lorenza Wörns, Marcus‐Alexander Liver Int Reviews Sorafenib and lenvatinib are approved for first‐line treatment of patients with advanced hepatocellular carcinoma (HCC), and the efficacy of atezolizumab plus bevacizumab has been demonstrated versus sorafenib. Over time, first‐line treatment frequently fails, and regorafenib, cabozantinib, ramucirumab (for patients with alpha fetoprotein ≥400 ng/mL), nivolumab, pembrolizumab and ipilimumab plus nivolumab are approved for use after sorafenib (but not lenvatinib) treatment in advanced HCC. Given the considerable complexity in the therapeutic landscape, the objective of this review was to summarize the clinical evidence for second‐line agents and provide practical guidance for selecting the best sequential treatment approach. The timing and sequencing of treatment switches are key to optimizing patient outcomes in advanced HCC, and decisions should be informed by reasons for discontinuation of previous therapy and disease progression. It is important not to switch too soon, because sequential treatment benefit may then be lost, nor should switching be delayed too long. Effectiveness, safety and tolerability, patient quality of life, route of administration, dosing regimen, drug class, molecular target and individual patients’ characteristics, including comorbidities, inform the selection of second‐line systemic treatment, independently of the aetiology of HCC, tumour stage and the response to previous treatment. Biomarkers predictive of treatment effectiveness are of great value, but currently biomarker‐driven patient selection is possible only in the case of ramucirumab. The approval of new combination therapies for advanced HCC in the first‐line setting will further increase the complexity of decision‐making. However, the important factors will remain the individual patient’s characteristics and preferences. John Wiley and Sons Inc. 2020-06-10 2020-08 /pmc/articles/PMC7496898/ /pubmed/32432830 http://dx.doi.org/10.1111/liv.14533 Text en © 2020 The Authors. Liver International published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Reviews Rimassa, Lorenza Wörns, Marcus‐Alexander Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma |
title | Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma |
title_full | Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma |
title_fullStr | Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma |
title_full_unstemmed | Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma |
title_short | Navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma |
title_sort | navigating the new landscape of second‐line treatment in advanced hepatocellular carcinoma |
topic | Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7496898/ https://www.ncbi.nlm.nih.gov/pubmed/32432830 http://dx.doi.org/10.1111/liv.14533 |
work_keys_str_mv | AT rimassalorenza navigatingthenewlandscapeofsecondlinetreatmentinadvancedhepatocellularcarcinoma AT wornsmarcusalexander navigatingthenewlandscapeofsecondlinetreatmentinadvancedhepatocellularcarcinoma |