Advanced HCC rx choices
1. Atezo Bev- 30% ORR median OS 19 months---> second line lenvatinib
2. Trem+ Durva STRIDE regimen ORR 20%
3. Sorafenib SHARP trial median OS 10-12 months
4. Lenvatinib OS 13 m, similar to sorafenib, but Len with 20% ORR versus 9% in sorafenib. Better PFS for Len---> second line atezo bev or IO
5. Tiselizumab is the only PD1 inhibitor found to work as a single agent ( neg trials for nivo and pembro versus sorafenib)
6. Camrelizumab and rivoceranib are not available outside China. This combo showed good outcomes
7. Second line: regorafenib,cabozatinib, and ramucirumab
TIGIT inhibitors represent a promising next-generation immunotherapy, particularly when combined with other checkpoint inhibitors, and are currently under active investigation for multiple solid and hematologic malignancies.
What is the role of liver-directed therapies in HCC?
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