The treatment landscape for hepatocellular carcinoma (HCC) has undergone a remarkable transformation in recent years, with the approval of several novel systemic therapies that have significantly improved outcomes for patients with advanced disease. In our recent webinar, we spoke with two leading experts in the field of liver cancer, Dr. Josep Llovet and Dr. Timothy Brown, who provided valuable insights into the evolving management of HCC.
Dr. Josep Llovet is a renowned figure in the world of liver cancer research. As the Liver Cancer Program director at the Icahn School of Medicine at Mount Sinai, he has played a pivotal role in advancing the understanding and treatment of this challenging disease. In addition to his academic appointments, Dr. Llovet has served as the president of the International Liver Cancer Association and has been recognized with prestigious awards, including the American Association for Cancer Research Landon International Award and the International Hans Popper Award. His extensive research and clinical expertise have made him a highly respected authority in the field. Our other expert, Dr. Timothy Brown, is an up-and-coming expert in managing gastrointestinal cancers, including HCC. As an Assistant Professor of Internal Medicine at the University of Texas Southwestern Medical Center, Dr. Brown’s research focuses on early-phase clinical trials and outcomes in these malignancies. He has been widely published in peer-reviewed journals and has received accolades, such as the Conquer Cancer Merit Award at the 2023 ASCO GI Cancer Symposium.
During the webinar, the discussion centered primarily on the evolving treatment landscape for HCC, particularly emphasizing the advancements in systemic therapies. Professor Llovet provided a comprehensive overview of the three distinct periods in managing advanced HCC. The first period, which lasted until 2007, was characterized by a lack of effective systemic therapies. This changed with the approval of sorafenib, a multi-kinase inhibitor, a landmark event in the field. Dr. Llovet highlighted the significant improvements in objective response rates and median survival observed with sorafenib and other TKIs, such as lenvatinib, compared to the dismal natural history of the disease. The second period began in the late 2000s and was marked by the approval of additional systemic therapies, including cabozantinib and ramucirumab. This era also saw the emergence of immunotherapy-based combinations, such as the approval of atezolizumab plus bevacizumab, which demonstrated superior outcomes compared to sorafenib in the frontline setting. The most recent period, which Llovet described as a “revolution,” has approved several additional immunotherapy-based combinations, including durvalumab plus tremelimumab and nivolumab plus ipilimumab. These combinations have expanded the treatment options for patients with advanced HCC and have shown impressive overall survival and response rates. Dr. Brown highlighted the significance of the approval of durvalumab plus tremelimumab, noting that this regimen provides an alternative option for patients who may not be suitable candidates for atezolizumab plus bevacizumab due to the increased risk of Bevacizumab-related side effects, such as hypertension and proteinuria.
The discussion also touched on the challenges of managing patients with impaired liver function, particularly those with Child-Pugh B cirrhosis. Both experts emphasized the importance of a multidisciplinary approach in assessing these patients and determining the appropriate course of treatment, considering the balance between efficacy and quality of life. Looking to the future, the experts discussed the promising areas of research in HCC, including the exploration of neoadjuvant and adjuvant systemic therapies, the potential of personalized vaccines, and the development of cellular therapies, such as CAR-T cells. Dr. Brown highlighted the need for head-to-head comparisons of modern HCC therapies and a better understanding of the role of second-line treatments in the post-immunotherapy era. The global impact of HCC was also a topic of discussion, with Professor Llovet emphasizing the significant burden of the disease, particularly in Asia and sub-Saharan Africa. He stressed the importance of preventive measures, such as hepatitis B vaccination and antiviral therapies, in reducing the incidence of HCC and the challenges of ensuring equitable access.
The discussion during this webinar provided a comprehensive overview of the remarkable progress made in managing patients with HCC and the ongoing challenges and promising research areas in this field. Both Dr. Llovet and Dr. Brown emphasized the critical importance of balancing efficacy and quality of life when selecting treatments for patients with advanced HCC, particularly those with impaired liver function. The experts stressed the need for a multidisciplinary approach to patient care and the potential of digital health technologies and artificial intelligence to enhance disease monitoring and guide treatment decisions. Looking to the future, the experts expressed excitement about the possibility of novel treatment modalities, such as personalized vaccines and cellular therapies, to improve outcomes for patients with HCC. However, they also highlighted the need for continued research, including head-to-head comparisons of modern systemic therapies and a better understanding of the role of second-line treatments in the post-immunotherapy era.
Ultimately, the insights shared during this webinar underscore the remarkable progress made in the field of liver cancer, as well as the ongoing challenges and opportunities that lie ahead. As the incidence of HCC continues to rise globally, the work of experts like Dr. Llovet and Dr. Brown will be crucial in driving further advancements and improving the lives of patients affected by this devastating disease.
Register to view the webinar here.
