New ASCO Guidelines on Systemic Therapy for Advanced HCC

The American Society of Clinical Oncology (ASCO) recently released updated guidelines on systemic therapy for patients with advanced hepatocellular carcinoma (HCC). ASCO has now published a companion piece answering common questions from clinicians on the topic.

The guideline update included recommendations for first-, second-, and third-line therapy options, as well as systemic therapy approaches for patients with Child-Pugh class A and B type disease.

ASCO first noted the factors to consider when choosing between atezolizumab plus bevacizumab or durvalumab plus tremelimumab for patients with Child-Pugh Class A advanced HCC. Data from the IMbrave150 study showed a major difference in progression-free survival with atezolizumab plus bevacizumab compared with sorafenib. In the HIMALAYA trial, researchers found a 25% 48-month overall survival rate for durvalumab plus tremelimumab and a prolonged median duration of response of over 22 months. ASCO noted that further research is needed to determine best first-line treatment options.

On the topic of prioritizing options in the second-line setting, ASCO stated that patient factors have the most impact on treatment decisions. As patient factors fluctuate over the course of treatment, clinicians should maximize patient access to recommended treatment options and continue to reassess appropriate treatments.

When considering the role of immune checkpoint inhibitors (ICIs) in the peritransplant setting, ASCO noted that while therapy with ICIs is not routinely recommended, it does not preclude orthotopic liver transplant. Systemic therapy with ICIs is a last resort treatment option in the post-transplant setting, with recent research demonstrating a 30% rate of acute rejection.

ASCO detailed the potential of combined local and systemic therapy options, including the LAUNCH trial, which investigated transarterial chemoembolization (TACE) plus lenvatinib versus lenvatinib alone. They also highlighted the TACTICS trial on TACE plus sorafenib and the EMERALD-1 study on TACE plus durvalumab and bevacizumab.

“We anticipate that results from locoregional systemic therapy studies will contribute to recommendations in the next iteration of this ASCO guideline,” ASCO wrote.