therapies, or drugs that affect the whole body, have seen the most evolution
since the previous guidelines, but some promising newer agents are still
considered experimental and are not included in this version.
recommended systemic drugs are targeted therapies that interfere with kinases,
a large family of enzymes that play a role in processes that allow cancer to
grow and spread.
(Nexavar) is the standard-of-care first-line
systemic therapy for people with advanced HCC or those with early tumours who
are either considered unsuitable for or who experience disease progression on
guidelines also recommend lenvatinib (Lenvima),
which has been found to be non-inferior to sorafenib, as an alternative first-line
therapy for people with advanced HCC and good liver function.
(Stivarga) is recommended as a
second-line treatment for people who experience disease progression on
sorafenib. Studies have also shown that cabozantinib (Cabometyx tablet formulation and Cometriq capsule formulation) improved survival in this patient
Galle noted that Eli Lilly recently announced results from a
study showing that ramucirumab (Cyramza),
a VEGF inhibitor that blocks blood vessel formation, increased overall survival
and progression-free survival in people with liver cancer with high AFP levels.
EASL does not yet recommend immunotherapy
for liver cancer. Last September the US Food and Drug Administration (FDA) approved nivolumab
(Opdivo) as second-line therapy for
people with HCC who were
previously treated with sorafenib, but it is not yet approved for this
indication in Europe.
Nivolumab is a monoclonal antibody that blocks PD-1, a receptor on T
cells that plays a role in
regulating immune function. Some tumours can use
PD-1 to turn off immune responses against them, and drugs that block PD-1 can
restore T-cell activity.
approval was based on promising findings
from the CheckMate 040 trial, which showed that nivolumab led to tumour shrinkage or disease
stabilisation in just over half of treated people. But the EASL panel noted
that this was an uncontrolled phase 2 study and they await phase 3 data.
very promising, but it's not recommended in Europe yet," Galle said.
therapies and immunotherapies work very well for some people with liver cancer,
but show little effectiveness for others. Experts do not yet know how to
predict which people will benefit, and development of predictive biomarkers
is one of the most active areas of cancer research
panel emphasised that the new EASL recommendations are intended to guide
clinical practice where all possible resources and therapies are available. The
members acknowledged that providers will have to make adjustments to account
for local regulations, drug availability, provider capacity, infrastructure and