SIR 2024
Interventional Oncology
Susie Park, MD
Physician
Harbor UCLA Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Min Tae Kim, MD
Radiology Resident
Harbor-UCLA Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Cherng Chao, MD
Physician
Harbor UCLA Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Learn the evolving state of medical therapies for HCC, including new combination therapies and use of medical therapy in the adjuvant setting.
Review the medical trial results and understand the differences between the medications.
Background:
Locoregional therapies provided by Interventional Radiologists have been the predominate treatment for HCC. Historically less than 20% of patients afflicted with HCC qualify for surgery and medical therapies for HCC have had low response rates. Recently, new effective medical therapies have been developed and are changing the treatment paradigm. The medical therapies include multi-receptor tyrosine kinase inhibitors, immunotherapies, monoclonal antibodies and combinations thereof. Now a new target, TIGIT (T cell immunoreceptor with Ig and ITIM domains), has also been shown to be an effective antibody target in combination therapy.
Clinical Findings/Procedure Details:
Medical therapies available to treat HCC currently include multi-receptor tyrosine kinase inhibitors (sorafenib, regorafenib, lenvatinib, cabozantinib, rivoceranib); monoclonal antibodies (ramucirumab and bevacizumab) which target vascular endothelial growth factor (VEGF); immunotherapies (nivolumab, atezolizumab, pembrolizumab, durvalumab, tremelimumab, camrelizumab); and now possibly anti-TIGIT antibodies (tiragolumab). The updated trial data of these therapies will compare overall survival and time to progression of disease as well as adverse effects. Important combination medical therapies will be reviewed including: 1) current first line combination medical therapies of atezolizumab and bevacizumab as well as tremelimumab and durvalumab; 2) rivoceranib and camrelizumab, a new combination regime (and may be possibly the longest to date); and 3) the addition of tiragolumab (anti-TIGIT antibody) to first line therapy to triple response rates of first line medical therapy. Two successful trials combining medical therapy and chemoembolization, TACTICS and LAUNCH, will be reviewed. Finally, we review the first phase 3 trial showing improved recurrence free survival with use of combination medical therapy (atezolizumab and bevacizumab) in the adjuvant setting after resection/ablation.
Conclusion and/or Teaching Points:
The rapid evolution of medical therapies for HCC is changing the paradigm for management and treatment of HCC. Interventional Radiologists treating HCC need to understand the new medical therapies because they may interact with IR treatments and may be used as adjuvant therapies to IR therapies.