Immunotherapy in hepatocellular carcinoma: Is there a light at the end of the tunnel?

Amit Mahipal, Sri Harsha Tella, Anuhya Kommalapati, Alexander Lim, Richard Kim

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer with dismal prognosis when diagnosed at advanced stages. Surgical resection of the primary tumor or orthotropic liver transplantation serves as a potential curative option. However, this approach is highly dependent on the hepatic reserve and baseline functional status of the patient. Liver directed therapies such as portal vein embolization (PVE), trans-arterial chemoembolization (TACE), and systemic chemotherapy are employed in non-surgical candidates. Sorafenib was the only approved systemic therapeutic agent for almost a decade until the recent approval of lenvatinib by the United States Food and Drug Administration (FDA) as an alternate first-line agent. Regorafenib, nivolumab, pembrolizumab and cabozantinib are approved by the FDA as second-line agents in patients who failed or could not tolerate sorafenib. Ramucirumab was recently FDA approved for the subset of patients that have high alfa-fetoprotein levels (>400 ng/mL). A better understanding of tumorigenesis and encouraging clinical trial results that evaluated immune-checkpoint inhibitors opened doors for immunotherapy in HCC. Immune checkpoint inhibitors have demonstrated a prolonged median overall and progression-free survival in a subset of patients with HCC. On-going translational and clinical research will hopefully provide us with a better understanding of tumor markers, genetic aberrations and other factors that determine the immunotherapy response in HCC. In this review, we sought to summarize the potential role and future directions of immunotherapy in the management of HCC.

Original languageEnglish (US)
Article number1078
JournalCancers
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2019

Fingerprint

Immunotherapy
Hepatocellular Carcinoma
United States Food and Drug Administration
Translational Medical Research
Liver
alpha-Fetoproteins
Proxy
Liver Neoplasms
Tumor Biomarkers
Portal Vein
Liver Transplantation
Disease-Free Survival
Carcinogenesis
Clinical Trials
Drug Therapy
Therapeutics
Neoplasms
sorafenib

Keywords

  • Immunotherapy
  • Lenvatinib
  • Liver cancer
  • Nivolumab
  • Sorafenib

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Immunotherapy in hepatocellular carcinoma : Is there a light at the end of the tunnel? / Mahipal, Amit; Tella, Sri Harsha; Kommalapati, Anuhya; Lim, Alexander; Kim, Richard.

In: Cancers, Vol. 11, No. 8, 1078, 01.08.2019.

Research output: Contribution to journalReview article

Mahipal, Amit ; Tella, Sri Harsha ; Kommalapati, Anuhya ; Lim, Alexander ; Kim, Richard. / Immunotherapy in hepatocellular carcinoma : Is there a light at the end of the tunnel?. In: Cancers. 2019 ; Vol. 11, No. 8.
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abstract = "Hepatocellular carcinoma (HCC) is the most common primary liver cancer with dismal prognosis when diagnosed at advanced stages. Surgical resection of the primary tumor or orthotropic liver transplantation serves as a potential curative option. However, this approach is highly dependent on the hepatic reserve and baseline functional status of the patient. Liver directed therapies such as portal vein embolization (PVE), trans-arterial chemoembolization (TACE), and systemic chemotherapy are employed in non-surgical candidates. Sorafenib was the only approved systemic therapeutic agent for almost a decade until the recent approval of lenvatinib by the United States Food and Drug Administration (FDA) as an alternate first-line agent. Regorafenib, nivolumab, pembrolizumab and cabozantinib are approved by the FDA as second-line agents in patients who failed or could not tolerate sorafenib. Ramucirumab was recently FDA approved for the subset of patients that have high alfa-fetoprotein levels (>400 ng/mL). A better understanding of tumorigenesis and encouraging clinical trial results that evaluated immune-checkpoint inhibitors opened doors for immunotherapy in HCC. Immune checkpoint inhibitors have demonstrated a prolonged median overall and progression-free survival in a subset of patients with HCC. On-going translational and clinical research will hopefully provide us with a better understanding of tumor markers, genetic aberrations and other factors that determine the immunotherapy response in HCC. In this review, we sought to summarize the potential role and future directions of immunotherapy in the management of HCC.",
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