Therapy Trends KOL Insight: Hepatocellular Carcinoma [2019]

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Publication Date:
May 2019
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How has the advent of novel systemic therapies impacted HCC?

Until 2017 the only approved systemic therapy for advanced hepatocellular carcinoma (HCC) was Bayer’s Nexavar. However now six additional therapies are approved: Stivarga (regorafenib; Bayer), Lenvima (lenvatinib; Eisai/Merck & Co.), Cabometyx (cabozantinib; Exelixis/Ipsen), Opdivo (nivolumab; BMS), Keytruda (pembrolizumab; Merck & Co.) and most recently Eli Lilly’s Cyramza (ramucirumab).  How are these agents faring on the market so far and what’s expected to happen to uptake in the future? Almost every agent is being tested in combination with another, but what do key opinion leaders (KOLs) think is the best approach? Learn how KOLs see the market evolving, and how they expect developers to differentiate their therapies in KOL Insight: Hepatocellular Carcinoma.

Twelve North American and European KOLs give their insight on seven marketed products and five pipeline programmes.

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Top takeaways

  • How has the arrival of new systemic therapies impacted the treatment of HCC? Six new systemic therapies are now approved for advanced HCC; how has this impacted treatment? Find out KOLs’ views on these agents and how the landscape will continue to evolve.
  • How has new first-line option Lenvima impacted established Nexavar? What do KOLs consider to be the differences between the two drugs? Find out how KOLs make prescribing decisions in the frontline.
  • How precarious is Stivarga’s position as a second-line therapy?  How do the experts currently view the new second-line therapies, and in particular what could be the impact of immunotherapy?
  • What is the future of immunotherapy in HCC? Immunotherapy was perceived as having great potential in HCC, but how do KOLs envisage its role playing out?
  • What is the future of systemic therapy in HCC? Do KOLs believe that usage of systemic therapy will change in the future, and what’s the potential impact on earlier stages of HCC?
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“Having had these drugs in your hands, we know that in a proportion of patients, these drugs are definitely effective, and what is very impressive, is the durability of response.” 
US Key Opinion Leader

“We will have many combinations that are more active than monotherapy. The immunotherapies in combination with other treatments will have the highest chance to be meaningful.” 
EU Key Opinion Leader

Sample of therapies covered

Marketed Therapies

  • Nexavar (sorafenib; Bayer)
  • Stivarga (regorafenib; Bayer)
  • Lenvima (lenvatinib; Eisai/Merck & Co.)
  • Cabometyx (cabozantinib; Exelixis/Ipsen)
  • Opdivo (nivolumab; Bristol-Myers Squibb)
  • Keytruda (pembrolizumab; Merck & Co.)
  • Cyramza (ramucirumab; Eli Lilly)

Pipeline Therapies

  • Tecentriq + Avastin (atezolizumab + bevacizumab; Roche)
  • Imfinzi (durvalumab; AstraZeneca)
  • tislelizumab (BeiGene/Celgene)
  • Pexa-Vec (pexastimogene devacirepvec; SillaJen/Transgene)
  • pegargiminase (Polaris)

KOLs interviewed

KOLs from North America

  • Kabir Mody, MD Consultant, Division of Hematology/Oncology, Department of Internal Medicine and Assistant Professor of Medicine at the Mayo Clinic, Jacksonville, FL
  • Richard S Finn, MD Assistant Professor of Medicine, Geffen School of Medicine, UCLA, Santa Monica, CA
  • Michael J Pishvaian, MD PhD Assistant Professor, Department of Hematology/Oncology and Head of the Phase I Program at the Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
  • Morris Sherman, PhD, MB  FRCPC FAASLD Associate Professor of Medicine, University of Toronto and Staff Gastroenterologist at the University Health Network and Mount Sinai Hospital, Toronto
  • Raymond T. Chung, MD Director of Hepatology and Liver Center, Massachusetts General Hospital and  Associate Professor of Medicine, Harvard Medical School, MA
  • Neerhar Parikh, MD MS Medical Director, Multidisciplinary Liver Tumor Clinic and Medical Director of the Living Donor Liver Transplantation Program, University of Michigan, MI

KOLs from Europe

  • Jean-Frederic Blanc, MD PhD Head of Digestive Oncology and Palliative Care, University of Bordeaux, France
  • David J Pinato, MD PhD MRCP Clinician Scientist and Consultant Medical Oncologist, Department of Surgery and Cancer, Imperial College London, UK
  • Lorenza Rimassa, MD ‎Deputy Manager, Head of Gastrointestinal Tumour Section, Humanitas Research Hospital, Milan, Italy
  • Tim Meyer, MBBS PhD FRCP Consultant in Medical Oncology and Professor in Experimental Cancer Medicine, UCL, UK
  • Anonymous KOL, MD PhD Professor of Gastrointestinal Oncology at a major University Hospital, Germany
  • Anonymous KOL, MD PhD Professor of Internal Medicine at a major University Hospital, Germany

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