Chemo/Immunotherapy Approach Is Promising in Intermediate-Stage Liver Cancer

The new approach of chemotherapy plus Opdivo offers “the best of both treatment approaches,” says one expert.

A new treatment option of transarterial chemoembolization (TACE) plus Opdivo (nivolumab) may be promising for patients with intermediate-stage liver cancer, according to findings from a clinical trial.

TACE is a method that delivers chemotherapy directly to the liver to kill cancer cells, while Opdivo is an immune checkpoint inhibitor that helps the immune system find and attack cancer.

“The idea was to combine basically the best of both treatment approaches, specifically in patients with liver-limited disease. (We used) TACE to get control of the tumor, maybe also destroy the tumor a bit, which could lead to an antigen release, which could prime the immune system to the checkpoint inhibitor,” said Dr. Arndt Vogel, head of the GI-Cancer Center at Medical School Hannover in Germany.

In the initial study, Vogel explained that he and other researchers were looking to see how many patients would respond – meaning have their tumor shrink – as a result of the treatment. The goal was a 55% response rate, which was surpassed with more than 70% of patients responding to treatment. However, it is too early to determine average overall survival and progression-free survival rates.

Fifty patients with intermediate-stage liver cancer were included in the study. They all received TACE and then a few days later were given Opdivo. They were then allowed to receive TACE again and continue on Opdivo. If a patient experienced disease progression at first, they were then allowed to get other localized (directly to the liver) therapy and/or continue on Opdivo.

These findings are particularly exciting in the field of liver cancer, which does not have as many known biomarkers as other cancers do. A biomarker is a protein or gene that can determine how patients respond to certain cancer treatments. For example, patients whose disease has high levels of PD-L1 – a protein that masks cancer cells from the immune system – tend to respond to checkpoint blockades like Opdivo.

“Unfortunately, we do not have any good molecular biomarkers at the moment, which could guide our treatment decisions,” Vogel said. “We discuss all of our patients in a multidisciplinary tumor board and then together, we decide what is the next best treatment, which includes a lot of local therapies, but also a lot of systemic (throughout the body) therapies that need to be based on the clinical presentation, the tumor burden and liver function at the moment.”

Vogel said that next steps can include potentially moving the Opdivo/TACE treatment up to earlier treatment settings and studying it in larger clinical trials.

“It looks like a very promising combination which should be pursued in subsequent and phase 3 clinical trials,” he said.

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