Cancer Therapy AdvisorASCO GI 2024: Data May Change Practice in HCC

Advancing Treatment Paradigms in Hepatocellular Carcinoma: A New Dawn of Therapeutic Strategies

The recent ASCO Gastrointestinal Cancers Symposium 2024 brought to light significant advancements in the management of hepatocellular carcinoma (HCC), offering new hope and potential changes in the standard care practices for this challenging malignancy. Groundbreaking studies presented at the symposium highlighted the efficacy of novel therapeutic combinations and strategies, underlining the importance of personalized and advanced treatment approaches in improving patient outcomes in HCC. This summary distills the core findings and critical takeaways from these presentations, aiming to provide healthcare professionals with concise, actionable insights into the evolving landscape of HCC treatment.

Key Points:

• Durvalumab plus bevacizumab and TACE has emerged as a potentially new standard of care for patients with unresectable HCC, demonstrating improved progression-free survival compared to TACE alone in the phase 3 EMERALD-1 trial.
• Adjuvant radiotherapy following resection with narrow margins (<1 cm) improved recurrence-free survival in patients with HCC, as evidenced by the phase 2 RAISE trial, suggesting its beneficial role in post-surgical management.
• A phase 2 trial exploring the combination of casdozokitug, atezolizumab, and bevacizumab revealed promising responses in patients with previously untreated, unresectable, or metastatic HCC, indicating the potential of novel immunotherapy combinations.
• Lenvatinib, tislelizumab, and TACE used as perioperative therapy showed safe and promising efficacy for patients with resectable HCC at high risk of recurrence, highlighting the importance of integrating systemic therapy with local treatments.
• The EMERALD-1 trial reported a median progression-free survival of 15.0 months for the combination therapy arm versus 8.2 months for TACE alone, underscoring the significant impact of adding durvalumab and bevacizumab to TACE.
• Patients in the RAISE trial demonstrated a 2-year recurrence-free survival rate of 78.74% with adjuvant radiotherapy versus 58.39% without, advocating for radiotherapy in specific post-resection scenarios.
• Treatment-related adverse events were reported across the studies, with a need for careful management and consideration of patient-specific factors to balance efficacy and safety.
• The diversity of the patient populations and treatment settings in these trials underscores the complexity of HCC management and the necessity for individualized treatment approaches.

“We believe that the data is certainly very compelling, and the combination of durvalumab and bevacizumab with TACE has the potential to set a new standard of care for unresectable HCC eligible for embolization. It is a true change of paradigm in the management of this patient population, for which TACE has remained the standard of care for more than 20 years, given the many negative phase 3 trials.”
– Study Presenter Riccardo Lencioni, MD, of Pisa University School of Medicine in Italy

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