AGA develops clinical practice guidelines on systemic therapy for HCC
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The AGA published 11 recommendations for systemic therapy in patients with hepatocellular carcinoma, which were featured in Gastroenterology.
“[The guidelines] address one aspect of treatment for HCC that has really changed in recent years,” Grace L. Su, MD, FAASLD, AGA spokesperson and professor of gastroenterology and hepatology at University of Michigan Health, told Healio. “Our target is specific patients with advanced HCC who are going to get what we call systemic therapy.
“[The paper] doesn’t address all the treatments; it just addresses a very specific set of treatments. We were only able to focus on the treatments that are already FDA approved recognizing that there's so many more treatments on the horizon.”
Su and colleagues in the AGA multidisciplinary group, which consists of technical review and guidelines panels, used the Grading of Recommendations Assessment, Development and Evaluation framework to evaluate evidence for the guidelines, as well as the Evidence-to-Decision framework to create recommendations.
“The main goal of this is to provide physicians who care for patients with HCC an unbiased assessment of these relatively new therapies for HCC,” Su said, “so they have a better understanding of the actual data and are able to sit down with their patients and assess risk and benefit.”
The 11 recommendations are:
- In patients with HCC with preserved liver function who are not eligible for locoregional treatments (LRT) or resection or with metastatic disease, atezolizumab plus bevacizumab is recommended over sorafenib.
- In patients who are not candidates for atezolizumab plus bevacizumab, lenvatinib or sorafenib is suggested over no systemic therapy.
- Cabozantinib is suggested over no system therapy.
- In patients who had progression of disease on sorafenib, pembrolizumab is recommended over no systemic therapy.
- In patients with preserved liver function and a-fetoprotein greater than 400 ng/mL who are not eligible for LRT or resection or with metastatic disease who had progression of disease on sorafenib, ramucirumab is recommended over no systemic therapy.
- In patients who had progression of disease on sorafenib, regorafenib is also suggested over no systemic therapy.
- In patients with poor liver function, routine use of sorafenib is not suggested.
- Adjuvant sorafenib therapy should not be used in patients undergoing curative surgical resection.
- Adjuvant sorafenib therapy should not be used in patients undergoing curative local ablation.
- Adjuvant sorafenib therapy should not be used in patients undergoing transarterial chemoembolization (TACE) LRT.
- Adjuvant bevacizumab therapy should not be used in patients undergoing TACE LRT.
“It's a very exciting time with all these new treatments,” Su said. “It's also complicated, because there's so many treatments and you have to figure out which one is the right one for a patient at a certain phase. Decisions are really made between the patient and doctor taking into consideration the patient’s preferences and values.”
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