2021 TDDW
Symposium (VI) FIRST LINE COMBINATION THERAPY OR SEQUENTIAL THERAPY FOR HCC
EXPANDING THE LANDSCAPE OF SYSTEMIC THERAPY FOR HCC: 2021 AND 2022 Ann-Lii Cheng Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan The combination of atezolizumab and bevacizumab (atezo-bev) has revolutionized the treatment of advanced HCC, for which prolonged tumor remission has now become commonplace. Atezo-bev also bring in unprecedented improvement of the quality of life for the patients. With the success of atezo-bev, systemic therapy is now being explored in early and intermediate stages of HCC. Contemporary guidelines for systemic therapy of HCC largely belong to two schools. The first school, including of ASCO and ESMO, indicates a preference for the use of atezo-bev for 1L therapy, and leaves sorafenib and lenvatinib for those who are unsuitable for atezo-bev. The second school, which consists of most of the other guidelines, depicts no preference of either sorafenib,
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lenvatinib, or atezo-bev for 1L therapy, and thus leaves room for physicians to make decision based on their individual real-world environments. Second-line treatment after atezo-bev or lenvatinib is becoming a predicament. At this point, a rational approach based on individualized treatment goals, as well as real world evidence is advised. Future landscape of development of systemic therapy includes combinations of multiple immune checkpoint inhibitors (CPI), novel CPIs, and combinations of CPI and multi-target tyrosine kinase inhibitors (TKI). Exploratory studies on triplet (e.g. double CPIs + TKI) are ongoing. We are truely in a new era of pursuing highly efficacious systemic therapy for HCC.
