Josep M. Llovet, MD, PhD, on Treatment Options in Hepatocellular Carcinoma

Dr Josep Llovet: So hepatocellular carcinoma is a major health problem globally. Is the second cause of cancer-related death, and there are around 1 million cases globally. Around 30% of the patients are diagnosed at an earlier stage, and are potentially treated with curative therapies, resection, liver transplantation, and local ablation. Then, 20 to 30% of the patients are diagnosed at intermediate stage. And currently the standard of care is transarterial embolization. And with the LEAP-012 study, we are proposing to switch the standard of care to lenvatinib, pembrolizumab, and TACE instead of TACE. And then, around 40 to 50% of the cases are diagnosed at advanced stages of the disease. Meaning, they have vascular invasion, lymph node involvement or extrahepatic spread, or ECOG performance status 1/2. And with these patients there have been a revolution in the management, even in the last 15 years. In front-line we have immune-based regimes, like atezolizumab plus bevacizumab, and durvalumab plus tremelimumab, and nivolumab plus ipilimumab. And for those patients that have contraindications for immune-based regimes, the current standard of care is lenvatinib or sorafenib. In patients progressing to these lines of therapy, both regorafenib and cabozantinib, and also a monoclonal antibody, ramucirumab, have shown also to impact in survival. So this gives you a picture of the current management of the disease throughout different stages.