Conference Coverage

New treatment options emerge for intermediate, advanced HCC


Key clinical point: New anti-VEGF options improve outcomes of intermediate-stage and advanced HCC.

Major finding: Progression-free survival was longer with TACE plus sorafenib vs. TACE alone (25.2 vs. 13.5 months; P = .006). Overall survival was longer with cabozantinib vs. placebo (10.2 vs. 8.0 months; P = .0049).

Data source: A randomized phase 2 trial among 156 patients with unresectable HCC (TACTICS trial). A randomized phase 3 trial among 707 patients with advanced HCC previously treated with sorafenib (CELESTIAL trial).

Disclosures: Dr. Kudo disclosed that he receives honoraria and research funding from, and has a consulting or advisory role with Bayer, among other disclosures; TACTICS was sponsored by the Japan Liver Oncology Group. Dr. Abou-Alfa disclosed that his institution receives research funding from Exelixis, among other disclosures; CELESTIAL was sponsored by Exelixis.

Source: Kudo M et al. GI Cancers Symposium, Abstract 206. Abou-Alfa GK et al. GI Cancers Symposium, Abstract 207.



– Two new therapies that target vascular endothelial growth factor signaling are efficacious and may expand the treatment armamentarium for intermediate and advanced hepatocellular carcinoma, data from a pair of randomized trials suggest.

In the phase 2 TACTICS (Transcatheter Arterial Chemoembolization Therapy in Combination With Sorafenib) trial, median progression-free survival, using a new, more narrow definition of progression, was almost a year longer when the oral tyrosine kinase inhibitor sorafenib (Nexavar) was added to transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC), translating to a 41% reduction in risk of events. This benefit came at the price of higher rates of certain grade 3 adverse events, but the combination was overall feasible and safe.

Dr. Jordi Brux of Barcelona Susan London/Frontline Medical News

Dr. Jordi Brux

In the phase 3 CELESTIAL trial, median overall survival was about 2 months longer with the oral tyrosine kinase inhibitor cabozantinib(Cabometyx, Cometriq) than with placebo among patients with advanced HCC who had previously received sorafenib, translating to a 24% reduction in risk of death. The rate of grade 3 or 4 adverse events was about twice as high with cabozantinib, but treatment discontinuation because of events was uncommon.

Results of both trials were reported at the 2018 GI Cancers Symposium, sponsored by the American Gastroenterological Association, the American Society for Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology.


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