The following article, written by Sapna Parmar, Senior Clinical Oncology Pharmacist at Oncology Analytics, is the third of a four-part series on key trends and findings from the 2020 American Society of Clinical Oncology (ASCO) Virtual Scientific Program, held May 29-31, 2020.
Hepatocellular carcinoma, or liver cancer, occurs when a malignant tumor grows in the liver. It is one of the most serious cancers in adults and causes more than 12,000 deaths per year in the United States. When liver cancer spreads, it most commonly involves the lungs and bones. Unfortunately, the 5-year survival rate for advanced cases is only 11 percent or less.
Symptoms of liver cancer include fatigue, jaundice (yellowing of the skin), pain, easy bruising or bleeding, and weight loss. The exact cause of liver cancer is not known; however, more than half of all people diagnosed have cirrhosis, a scarring condition of the liver commonly caused by chronic alcohol abuse and viral hepatitis.
Former heavyweight champion “Smokin’” Joe Frazier was the first man to beat Muhammad Ali in the Fight of the Century. Frazier was diagnosed in 2011 with liver cancer. Sadly, his disease was advanced at diagnosis. He was initially treated on hospice and died of the disease within only a few months.
If liver cancer is caught early, it can sometimes be cured with surgery or transplant. In more advanced cases, a cure is not possible, but treatment can help patients live longer and better. Until recently, the only treatment options for patients with newly diagnosed liver cancer were oral medications called tyrosine kinase inhibitors – sorafenib and lenvatinib. These medications are not always tolerated by patients due to considerable side effects that may impair quality of life. Additionally, sorafenib has a response rate of approximately 10%. Groundbreaking research from #ASCO20 reported that immunotherapy can now be used for the initial treatment of patients with liver cancer. Immunotherapy involves the use of medicines that help a person’s own immune system target and destroy cancer cells. The immune checkpoint inhibitor atezolizumab targets the PD-L1 protein on tumor cells. Blocking this protein can help boost the immune response against cancer cells, which in turn can shrink some tumors or slow their growth.
Recently published in the New England Journal of Medicine was a promising study (called IMbrave150) that evaluated atezolizumab in combination with bevacizumab (a targeted drug against vascular endothelial growth factor) as a first-line treatment option for patients with liver cancer that has spread to other organs and cannot be treated with surgery. This phase 3 study randomized patients to receive either atezolizumab plus bevacizumab or sorafenib. Overall survival at 12 months was 67.2% with atezolizumab plus bevacizumab compared to 54.6% with sorafenib. In addition, the median progression-free survival was 6.8 months in the atezolizumab plus bevacizumab group versus 4.3 months in the sorafenib group.
This is the first study in 11 years to show an improvement in survival with a new first-line treatment option compared to sorafenib, which has been the standard of care throughout this time. Atezolizumab plus bevacizumab will certainly be a practice-changing treatment option for patients with liver cancer.
Following the pivotal IMbrave150 study, Arndt Vogel and colleagues presented a meta-analysis at #ASCO20 comparing the efficacy of atezolizumab plus bevacizumab with other systemic and local therapies approved for liver cancer. The results of their analysis concluded that there are greater overall survival and progression-free survival benefits with first-line atezolizumab plus bevacizumab treatment compared to other therapies approved for patients with advanced liver cancer. An analysis of patient-reported outcomes showed less deterioration in quality of life, physical functioning, and role functioning with the combination of atezolizumab plus bevacizumab therapy. Research studies like IMbrave150 are critical to help all patients live longer, better lives, and keep the legacies of greats like Frazier alive.