BackTable / VI / Podcast / Episode #402

Immunotherapy in HCC: Evolving Treatment Paradigms

with Dr. Tyler Sandow, Dr. Edward Kim and Dr. Terence Gade

In this episode, Dr. Tyler Sandow (Ochsner Health) interviews interventional radiologists Dr. Edward Kim (Mount Sinai) and Dr. Terence Gade (University of Pennsylvania) about the future directions of hepatocellular carcinoma (HCC) treatments, specifically focusing on the adoption of precision medicine and multidisciplinary approaches.

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Podcast Contributors

Dr. Tyler Sandow

Dr. Tyler Sandow is an interventional radiologist with Ochsner Health in New Orleans, Louisiana.

Dr. Edward Kim

Dr. Edward Kim is the director of interventional oncology and a professor of radiology and surgery in the division of vascular and interventional radiology at the Mount Sinai Medical Center in New York City.

Dr. Terence Gade

Dr. Terence Gade is a practicing interventional radiologist with at the University of Pennsylvania.

Synopsis

They delve into various HCC treatments, including locoregional therapies like transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), as well as the roles of systemic immunotherapies and checkpoint inhibitors. They highlight the importance of sequential order and timing of treatments and the use of imaging biomarkers for individualized cancer care.

Throughout the discussion, influential clinical trials in HCC treatment are discussed and summarized. The doctors unanimously agree that as the sphere of interventional oncology is rapidly evolving, the focus should be centered on providing the most effective and patient-specific care with a deep understanding of combination therapies.

Timestamps

00:00 - Introduction
05:45 - The Beginnings of Systemic Therapy for HCC
08:28 - The Role of Immunotherapy in HCC Treatment
11:09 - Multidisciplinary Clinics and Tumor Boards
20:21 - The Society of Interventional Oncology and Treatment Guidelines
24.59 - Choosing Between Locoregional and Combination Therapies
39:17 - The Use of Immunotherapy in Early Stage Patients
42:08 - Current Safety Data for Immunotherapy
48.56 - TACE Drug Choice
53:16 - How to Approach Treatment of Multifocal or Large Tumors
01:00 - Timeline for Imaging to Assess Treatment Response
01:03 - The Future of Immunotherapy and Interventional Oncology

Resources

Society of Interventional Oncology (SIO):
https://www.sio-central.org/

Sorafenib in Advanced Hepatocellular Carcinoma (SHARP Trial)
https://www.nejm.org/doi/full/10.1056/nejmoa0708857

Efficacy and Safety of Sorafenib in Patients in the Asia-Pacific region with Advanced Hepatocellular Carcinoma:
https://pubmed.ncbi.nlm.nih.gov/19095497/

Efficacy and Safety of Nivolumab Plus Ipilimumab in Patients With Advanced Hepatocellular Carcinoma Previously Treated With Sorafenib (CheckMate 040 Trial):
https://jamanetwork.com/journals/jamaoncology/fullarticle/2771012

Tremelimumab and Durvalumab as First-line Therapy in Patients with Unresectable Hepatocellular Carcinoma (HIMALAYA Trial):
https://ascopubs.org/doi/10.1200/JCO.2022.40.4_suppl.379

Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma (IMbrave 150 Trial):
https://www.nejm.org/doi/full/10.1056/nejmoa1915745

Lenvatinib Combined With Transarterial Chemoembolization as First-Line Treatment for Advanced Hepatocellular Carcinoma (LAUNCH Trial):
https://ascopubs.org/doi/abs/10.1200/JCO.22.00392

Randomised, Multicentre Prospective Trial of Transarterial Chemoembolisation Plus Sorafenib as Compared with TACE Alone in Patients with Hepatocellular Carcinoma (TACTICS Trial):
https://pubmed.ncbi.nlm.nih.gov/31801872/

Uncoupling Immune Trajectories of Response and Adverse Events from Anti-PD-1 Immunotherapy in Hepatocellular Carcinoma:
https://pubmed.ncbi.nlm.nih.gov/35430299/

Personalised Versus Standard Dosimetry Approach of Selective Internal Radiation Therapy in Patients with Locally Advanced Hepatocellular Carcinoma (DOSISPHERE-01 Trial):
https://pubmed.ncbi.nlm.nih.gov/33166497/

Radiation Segmentectomy for Curative Intent of Unresectable Very Early to Early Stage Hepatocellular Carcinoma (RASER Trial):
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00091-7/fulltext

Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma:
https://journals.lww.com/ajg/abstract/2023/12000/immunotherapy_and_transarterial_radioembolization.23.aspx

Neoadjuvant Cabozantinib and Nivolumab Convert Locally Advanced Hepatocellular Carcinoma into Resectable Disease with Enhanced Antitumor Immunity:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8594857/

Safety of Combined Yttrium-90 Radioembolization and Immune Checkpoint Inhibitor Immunotherapy for Hepatocellular Carcinoma:
https://pubmed.ncbi.nlm.nih.gov/31422022/

Safety and Efficacy of Liver Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma After Segmental Transarterial Radioembolization:
https://pubmed.ncbi.nlm.nih.gov/31536781/

EMERALD-1 Trial:
https://www.astrazeneca.com/media-centre/press-releases/2023/imfinzi-combination-improves-pfs-in-liver-cancer.html

Randomized Trial of Hepatic Artery Embolization for Hepatocellular Carcinoma Using Doxorubicin-Eluting Microspheres Compared With Embolization With Microspheres Alone:
https://pubmed.ncbi.nlm.nih.gov/26834067/

Transcript Preview

[Dr. Edward Kim]
You can also see it as an opportunity to engage with your medical oncologist to teach them about what you do and the importance if local regional therapy, especially a trans-arterial based therapy, is going to be in play, why it's important to send the patient to you a little bit earlier if they're thinking about it. Because I guarantee you, your medical oncologist has no idea of what you do and the effects of all of that.
They just know from a cerebral standpoint, okay, Bev may because some problems for my interventional radiologist, but if you engage with them and explain to them exactly what you do, they may decide, okay, what? I may not use the Bev. I may go more towards a TACE or a Y90 first.

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Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

Current Practices In Combination Therapy for Hepatocellular Carcinoma

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Topics

Hepatocellular Carcinoma Condition Overview

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