TY - JOUR
T1 - Systemic Therapy for Advanced Hepatocellula Carcinoma
T2 - ASCO Guideline
AU - Gordan, John D.
AU - Kennedy, Erin B.
AU - Abou-Alfa, Ghassan K.
AU - Beg, Muhammad Shaalan
AU - Brower, Steven T.
AU - Gade, Terence P.
AU - Goff, Laura
AU - Gupta, Shilpi
AU - Guy, Jennifer
AU - Harris, William P.
AU - Iyer, Renuka
AU - Jaiyesimi, Ishmael
AU - Jhawer, Minaxi
AU - Karippot, Asha
AU - Kaseb, Ahmed O.
AU - Kate Kelley, R.
AU - Knox, Jennifer J.
AU - Kortmansky, Jeremy
AU - Leaf, Andrea
AU - Remak, William M.
AU - Shroff, Rachna T.
AU - Sohal, Davendra P.S.
AU - Taddei, Tamar H.
AU - Venepalli, Neeta K.
AU - Wilson, Andrea
AU - Zhu, Andrew X.
AU - Rose, Michal G.
N1 - Publisher Copyright:
Copyright © 2020 American Society of Clinical Oncology. All rights reserved.
PY - 2020/12/20
Y1 - 2020/12/20
N2 - 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 1 bevacizumab (atezo 1 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 1 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 a-fetoprotein $ 400 ng/mL), or atezo 1 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 1 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.
AB - 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 1 bevacizumab (atezo 1 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 1 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 a-fetoprotein $ 400 ng/mL), or atezo 1 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 1 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.
UR - http://www.scopus.com/inward/record.url?scp=85096897179&partnerID=8YFLogxK
U2 - 10.1200/JCO.20.02672
DO - 10.1200/JCO.20.02672
M3 - Review article
C2 - 33197225
AN - SCOPUS:85096897179
SN - 0732-183X
VL - 38
SP - 4317
EP - 4345
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 36
ER -