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Abstract Details
Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline
J Clin Oncol. 2020 Dec 20;38(36):4317-4345. doi: 10.1200/JCO.20.02672. Epub 2020 Nov 16.
John D Gordan1, Erin B Kennedy2, Ghassan K Abou-Alfa3, Muhammad Shaalan Beg4, Steven T Brower5, Terence P Gade6, Laura Goff7, Shilpi Gupta8, Jennifer Guy9, William P Harris10, Renuka Iyer11, Ishmael Jaiyesimi12, Minaxi Jhawer13, Asha Karippot14, Ahmed O Kaseb15, R Kate Kelley1, Jennifer J Knox16, Jeremy Kortmansky17, Andrea Leaf18, William M Remak19, Rachna T Shroff20, Davendra P S Sohal21, Tamar H Taddei22, Neeta K Venepalli23, Andrea Wilson24, Andrew X Zhu25, Michal G Rose26
Author information
1University of California, San Francisco, San Francisco, CA.
2American Society of Clinical Oncology, Alexandria, VA.
3Memorial Sloan Kettering Cancer Center, Weill Medical College at Cornell University, New York, NY.
4UT Southwestern, Dallas, TX.
5Lefcourt Family Cancer Treatment and Wellness Center, Englewood, NJ.
6Penn Medicine, Philadelphia, PA.
7Vanderbilt Ingram Cancer Center, Nashville, TN.
8Weill Cornell Medicine, New York, NY.
9Sutter Health, San Francisco, CA.
10UW Medicine, Seattle, WA.
11Roswell Park Comprehensive Cancer Center, Buffalo, NY.
12Beaumont Hospital, Royal Oak, MI.
13Englewood Hospital, Englewood, NJ.
14Cancer Treatment Centers of America, Tulsa, OK.
15MD Anderson Cancer Center, Houston, TX.
16Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
17Yale Cancer Center, New Haven, CT.
18VA New York Harbor Healthcare System, Brooklyn, NY.
19California Hepatitis C Task Force, California Chronic Care Coalition, FAIR Foundation, San Francisco, CA.
20University of Arizona Cancer Center, Tucson, AZ.
21University of Cincinnati, Cincinnati, OH.
22Yale University School of Medicine and VA Connecticut Healthcare System, West Haven, CT.
23University of Illinois Hospital, Chicago, IL.
24Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, AL.
25Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA.
26Yale Cancer Center and VA Connecticut Healthcare System, West Haven, CT.
Abstract
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 + bevacizumab (atezo + 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 + 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 α-fetoprotein ≥ 400 ng/mL), or atezo + 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 + 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.