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A panel of international oncology experts recently met to exchange thoughts on developments in the field of hepatocellular carcinoma (HCC), the most common form of liver cancer. They discussed screening and staging issues, treatment of advanced HCC and results of recent clinical trials.
Treating hepatocellular carcinoma (HCC), the most common form of liver cancer, is exceptionally challenging today. Even as new therapies are on the horizon that show some promise, delays in diagnosis can derail their potential effectiveness. Many people diagnosed with cancer also suffer from other diseases, or comorbidities, which can complicate treatment as well.
A group of international oncology experts convened by OncLive Peer Exchange® met recently to provide a global perspective on HCC. The panel discussed screening and staging issues, treatment of advanced HCC, and results of recent clinical trials. At the start of the discussion, moderator Richard S. Finn, M.D., noted that HCC encompasses a “diverse group of malignancies with a global impact.”
“Hepatocellular carcinoma is the fifth most common [cancer] worldwide,” said panelist Amit Singal, M.D., M.S. He said the highest rates of HCC are in East Asia and Africa, where the primary driver is hepatitis B virus (HBV). Rates of HCC are lower in the United States and Europe, where hepatitis C virus (HCV) causes most cases.
Less common causes are nonalcoholic steatohepatitis (NASH) and excessive alcohol consumption, both of which contribute to cirrhosis.
Singal said he expects the advent of curative direct-acting antiviral agents (DAAs) for HCV to change the future of HCC in the United States and Europe, leading to lower rates and a shift in HCC etiology toward metabolic causes of cirrhosis. Data already show an increase in the incidence of NASH-induced HCC in the United States stemming from the growing prevalence of diabetes and obesity.
Surgical resection or transplant remain the only cure for HCC. Finn said although HCC survival outcomes have started to improve, many patients have cirrhosis and other comorbidities that complicate management. As with most cancers, early diagnosis and intervention can significantly improve survival.
In the United States, excitement has been building among HCC specialists since April, when the FDA approved Stivarga (regorafenib) as a second-line treatment for patients with HCC following prior Nexavar (sorafenib). Nexavar was the only approved systemic therapy in HCC for a decade as a series of late-stage clinical trials failed to produce additional therapies.
In September, the FDA granted an accelerated approval to Opdivo (nivolumab) for patients with HCC following prior Nexavar. The agency also has accepted a supplemental new drug application (sNDA) for Lenvima (lenvatinib), a VEGF inhibitor, as a frontline systemic treatment for patients with advanced HCC.
In another development, Cabometyx (cabozantinib), a multikinase inhibitor, improved median overall survival (OS) versus placebo in patients with advanced HCC who have previously received Nexavar in the phase 3 CELESTIAL trial, meeting the primary endpoint. Based on these results, Exelixis, the company developing the drug, plans to submit an sNDA to the FDA in the first quarter of 2018.
Read the rest of this very good article here: https://www.curetoday.com/articles/global-perspectives-on-hepatocellular-carcinoma