In:
Visceral Medicine, S. Karger AG, Vol. 37, No. 2 ( 2021), p. 87-93
Kurzfassung:
〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The number of efficacious systemic agents for advanced hepatocellular carcinoma (HCC) has rapidly increased over the past 3 years. However, guidance for optimal sequential systemic treatment in patients with advanced disease and experience with outcome and safety profiles are lacking. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 We aimed to assess efficacy and tolerability of sequential systemic therapy of advanced HCC. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Our single-center study prospectively followed 14 patients who received multiple, sequential systemic therapies after progression or intolerance to sorafenib. Endpoints were overall and progression-free survival (OS, PFS), objective response rate (ORR), and treatment-emergent adverse events (TEAE). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Patients had well-compensated liver function and good performance status at start of each systemic therapy. Agents included sorafenib ( 〈 i 〉 n 〈 /i 〉 = 14), regorafenib ( 〈 i 〉 n 〈 /i 〉 = 10), immunotherapy with nivolumab or pembrolizumab ( 〈 i 〉 n 〈 /i 〉 = 10), lenvatinib ( 〈 i 〉 n 〈 /i 〉 = 3), ramucirumab ( 〈 i 〉 n 〈 /i 〉 = 2), and others, with a median of 3 lines of systemic therapy per patient. Median OS was 37.4 months from initiation of first-line therapy with sorafenib. PFS and ORR for sorafenib, regorafenib, and immunotherapy were 6.6, 5.3, and 6.6 months, and 15.4, 11.1, and 22.2%, respectively. TEAE were frequent (46–80%), but mostly manageable during tyrosine kinase inhibitor therapy and without the need for termination in most patients. However, TEAE due to immunotherapy (60%) led to cessation of treatment in 40% of the patients. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Sequential systemic therapy is able to prolong median OS in selected patients with advanced HCC to more than 3 years. TEAE are frequent, but manageable, and the quality of adverse events depends on the respective agent. Further investigation of potential predictive biomarkers for treatment allocation is needed.
Materialart:
Online-Ressource
ISSN:
2297-4725
,
2297-475X
Sprache:
Englisch
Verlag:
S. Karger AG
Publikationsdatum:
2021
ZDB Id:
2850734-4
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