John D Gordan1, Erin B Kennedy2, Ghassan K Abou-Alfa3, Muhammad Shaalan Beg4, Steven T Brower5, Terence P Gade6, Laura Goff7, Shilpi Gupta8, Jennifer Guy9, William P Harris10, Renuka Iyer11, Ishmael Jaiyesimi12, Minaxi Jhawer13, Asha Karippot14, Ahmed O Kaseb15, R Kate Kelley1, Jennifer J Knox16, Jeremy Kortmansky17, Andrea Leaf18, William M Remak19, Rachna T Shroff20, Davendra P S Sohal21, Tamar H Taddei22, Neeta K Venepalli23, Andrea Wilson24, Andrew X Zhu25, Michal G Rose26. 1. University of California, San Francisco, San Francisco, CA. 2. American Society of Clinical Oncology, Alexandria, VA. 3. Memorial Sloan Kettering Cancer Center, Weill Medical College at Cornell University, New York, NY. 4. UT Southwestern, Dallas, TX. 5. Lefcourt Family Cancer Treatment and Wellness Center, Englewood, NJ. 6. Penn Medicine, Philadelphia, PA. 7. Vanderbilt Ingram Cancer Center, Nashville, TN. 8. Weill Cornell Medicine, New York, NY. 9. Sutter Health, San Francisco, CA. 10. UW Medicine, Seattle, WA. 11. Roswell Park Comprehensive Cancer Center, Buffalo, NY. 12. Beaumont Hospital, Royal Oak, MI. 13. Englewood Hospital, Englewood, NJ. 14. Cancer Treatment Centers of America, Tulsa, OK. 15. MD Anderson Cancer Center, Houston, TX. 16. Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 17. Yale Cancer Center, New Haven, CT. 18. VA New York Harbor Healthcare System, Brooklyn, NY. 19. California Hepatitis C Task Force, California Chronic Care Coalition, FAIR Foundation, San Francisco, CA. 20. University of Arizona Cancer Center, Tucson, AZ. 21. University of Cincinnati, Cincinnati, OH. 22. Yale University School of Medicine and VA Connecticut Healthcare System, West Haven, CT. 23. University of Illinois Hospital, Chicago, IL. 24. Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, AL. 25. Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA. 26. Yale Cancer Center and VA Connecticut Healthcare System, West Haven, CT.
Abstract
PURPOSE: To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with advanced hepatocellular carcinoma (HCC). METHODS: ASCO convened an Expert Panel to conduct a systematic review of published phase III randomized controlled trials (2007-2020) on systemic therapy for advanced HCC and provide recommended care options for this patient population. RESULTS: Nine phase III randomized controlled trials met the inclusion criteria. RECOMMENDATIONS: Atezolizumab + bevacizumab (atezo + bev) may be offered as first-line treatment of most patients with advanced HCC, Child-Pugh class A liver disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1, and following management of esophageal varices, when present, according to institutional guidelines. Where there are contraindications to atezolizumab and/or bevacizumab, tyrosine kinase inhibitors sorafenib or lenvatinib may be offered as first-line treatment of patients with advanced HCC, Child-Pugh class A liver disease, and ECOG PS 0-1. Following first-line treatment with atezo + bev, and until better data are available, second-line therapy with a tyrosine kinase inhibitor may be recommended for appropriate candidates. Following first-line therapy with sorafenib or lenvatinib, second-line therapy options for appropriate candidates include cabozantinib, regorafenib for patients who previously tolerated sorafenib, or ramucirumab (for patients with α-fetoprotein ≥ 400 ng/mL), or atezo + bev where patients did not have access to this option as first-line therapy. Pembrolizumab or nivolumab are also reasonable options for appropriate patients following sorafenib or lenvatinib. Consideration of nivolumab + ipilimumab as an option for second-line therapy and third-line therapy is discussed. Further guidance on choosing between therapy options is included within the guideline. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
PURPOSE: To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with advanced hepatocellular carcinoma (HCC). METHODS:ASCO convened an Expert Panel to conduct a systematic review of published phase III randomized controlled trials (2007-2020) on systemic therapy for advanced HCC and provide recommended care options for this patient population. RESULTS: Nine phase III randomized controlled trials met the inclusion criteria. RECOMMENDATIONS: Atezolizumab + bevacizumab (atezo +bev) may be offered as first-line treatment of most patients with advanced HCC, Child-Pugh class A liver disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1, and following management of esophageal varices, when present, according to institutional guidelines. Where there are contraindications to atezolizumab and/or bevacizumab, tyrosine kinase inhibitors sorafenib or lenvatinib may be offered as first-line treatment of patients with advanced HCC, Child-Pugh class A liver disease, and ECOG PS 0-1. Following first-line treatment with atezo +bev, and until better data are available, second-line therapy with a tyrosine kinase inhibitor may be recommended for appropriate candidates. Following first-line therapy with sorafenib or lenvatinib, second-line therapy options for appropriate candidates include cabozantinib, regorafenib for patients who previously tolerated sorafenib, or ramucirumab (for patients with α-fetoprotein ≥ 400 ng/mL), or atezo +bev where patients did not have access to this option as first-line therapy. Pembrolizumab or nivolumab are also reasonable options for appropriate patients following sorafenib or lenvatinib. Consideration of nivolumab + ipilimumab as an option for second-line therapy and third-line therapy is discussed. Further guidance on choosing between therapy options is included within the guideline. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
Authors: Giuseppe Cabibbo; Maria Reig; Ciro Celsa; Ferran Torres; Salvatore Battaglia; Marco Enea; Giacomo Emanuele Maria Rizzo; Salvatore Petta; Vincenza Calvaruso; Vito Di Marco; Antonio Craxì; Amit G Singal; Jordi Bruix; Calogero Cammà Journal: Liver Cancer Date: 2021-11-23 Impact factor: 11.740