Ghassan K. Abou-Alfa, MD: Sadly, many of the patients who get the surgical resection, many of the patients who get transplanted, way many patients who receive the local therapy, and of course many others who start to begin with, they get what we call “spread out cancer,” or what’s called metastatic disease. In other words, the cancer goes beyond their liver. And in that instance, we need what we call systemic therapy, being either pills or intravenous, or some form of therapy that will go wherever the cancer is, wherever it might be, wherever it might go. A classic example for this is a drug that is called sorafenib—yet you probably better know it under its brand name, Nexavar—which is a form of pills that is able to control the cancer.
Interestingly, in 2017 and 2018, the story has changed markedly. After we learned for 10 years that the only treatment that works is Nexavar, nowadays we have much more that could work, among which one of them is called Stivarga, or regorafenib. It’s another form of therapy that works similar to Nexavar and that can be used in patients who fail Nexavar. In addition to that, there’s lenvatinib, or known as Lenvima. It’s not FDA approved but it’s approved for other indications, but the expectation is it will be approved as well. That has shown to be equivalent to Nexavar in a certain study that was done, but also it has certain added assets to the Nexavar. After this, there is another drug called cabozantinib, which has shown in the second-line setting—in other words, second line means patients who failed some first-line treatment like Nexavar—it would be also effective. So, no doubt there are plenty of options in regard to the treatment of liver cancer.
I’m still talking only about one aspect of the therapy, which is the form of pills that I mentioned, that targets or goes after a specific receptor on those tumors or a specific change in those tumors. But believe it or not, immunotherapy has a lot of say in regard to the treatment of liver cancer patients. And if anything, Opdivo, which probably you’re well familiar with because you hear about it here and there. It is known as nivolumab and already is approved for liver cancer in the second-line setting. And this is pending some further testing to confirm that approval. But on the other hand, there also are other therapies that are still under study that are of the immunotherapy nature, and I expect that this will hopefully give, or provide, our patients with many more options than we already had beforehand.