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Andrea Martirena: Systemic management of advanced HCC

Andrea Martirena/X

Feb 20, 2025, 08:52

Andrea Martirena: Systemic management of advanced HCC

Andrea Martirena, Medical Oncology Resident at Department of Medical Oncology – OncoHealth Institute – Health Research Institute, shared an article she and colleagues authored on X:

“Systemic management of advanced HCC: an increasingly complex game.

Full text here.”

Systemic management of advanced HCC: an increasingly complex game

Authors: Andrea Martirena et al.

Andrea Martirena: Systemic management of advanced HCC

The treatment landscape for advanced hepatocellular carcinoma (HCC) has evolved significantly with the introduction of immune checkpoint inhibitors (ICIs), specifically PD-1/PD-L1 and CTLA-4 inhibitors. Several first-line therapy options are available, but no biomarkers exist to guide treatment selection.

Four major phase III clinical trials have demonstrated the efficacy of immunotherapy over tyrosine kinase inhibitors (TKIs):

1. IMbrave150 – Atezolizumab + Bevacizumab
2. HIMALAYA – Tremelimumab + Durvalumab
3. CARES-310 – Camrelizumab + Rivoceranib
4. CheckMate 9DW – Nivolumab + Ipilimumab

All four improved overall survival (OS), with benefits generally consistent across clinical subgroups. The CheckMate 9DW trial reported the highest objective response rate (ORR) of 36%, followed by IMbrave150 (30%).

The lack of predictive biomarkers complicates treatment selection, leaving decisions reliant on clinical factors and toxicity profiles. While atezolizumab + bevacizumab remains the preferred regimen for most patients, tremelimumab + durvalumab offers a lower-toxicity alternative, and nivolumab + ipilimumab may benefit select patients despite higher immune-related toxicity.

With comparable efficacy across etiologies, including non-viral HCC, treatment choice hinges on balancing response rates, toxicity, and patient-specific contraindications. Future research must focus on biomarker discovery to personalize therapy further.

Andrea Martirena: Systemic management of advanced HCC