10 developments in liver cancer

Discovering links between hepatocellular carcinoma and direct-acting antivirals, exploring risk factors for HCC, conducting clinical trials of new medications for the disease — these are just some of the ways researchers are working towards finding a cure for liver cancer. Hepatocellular carcinoma — according to one report — will take 27,000 lives this year and another 40,000 cases will be diagnosed. Earlier this year, the Annual Report to the Nation on the Status of Cancer reported deaths by hepatocellular carcinoma held the highest rate of all common cancers between 2003 and 2012.

In recognition of October being Liver Cancer Awareness Month, Healio.com/Hepatology highlights 10 of the most popular articles regarding HCC over the past year.

1. Nearly one-third of patients with previous HCC recur after DAA therapy

BARCELONA — Though hepatocellular carcinoma after direct-acting antiviral therapy rarely occurs, patients with a history of HCC recurred at a rate of 29%, according to a presenter at the International Liver Congress.

“The facts are that we currently have two independent studies from two different countries showing similar results that these high rate, early recurrence of HCC in patients treated with DAA with previous HCC. This is unexpected. We suspect that it is a disruption of immune surveillance because this has not been seen with the previous treatment” Laurent Castera, MD, PhD, and EASL secretary-general, told Healio.com/Hepatology. Read more

2. First patient treated in phase 3 trial for HCC medication Pexa-Vec

Researchers at the University of Tennessee Medical Center have treated the first patient in the phase 3 clinical trial for the hepatocellular carcinoma medication Pexa-Vec, according to a press release.

“We are at the forefront of bringing innovative cancer treatment to patients,” Laura Findeiss, MD, professor and chair of the department of radiology at the University of Tennessee Medical Center and UT Graduate School of Medicine, said in the release. “I remain excited about the potential this new cancer immunotherapy holds.” Read more

3. SILIUS: Nexavar plus chemotherapy fails to improve overall survival in HCC

BARCELONA —  Nexavar plus a chemotherapy regimen was not superior to Nexavar alone in improving overall survival in a cohort of patients with hepatocellular carcinoma, according to findings presented at the International Liver Congress.

However, Masatoshi Kudo, MD, of Kinki University Hospital in Osaka-Sayama, Japan, noted that OS was significantly better in patients who responded to either sorafenib or combination therapy than in non-responders. Read more

4. Undetected cirrhosis common at HCC diagnosis

In a U.S. Veteran population, a majority of patients with hepatocellular carcinoma had undetected cirrhosis at the time carcinoma was diagnosed. These patients were also more likely to have advanced stage HCC, according to research published in Alimentary Pharmacology and Therapeutics.

“The failure to recognize cirrhosis was strongly associated with advanced stage at the time of HCC diagnosis,” the researchers wrote. Read more

5. Stivarga increases OS in patients with unresectable HCC

Bayer announced results of its phase 3 RESORCE clinical trial, indicating Stivarga improved overall survival in patients with unresectable hepatocellular carcinoma.

The safety and tolerability of the drug were consistent with the known profile of regorafenib, according to a press release. Read more

6. Diabetes, metabolic syndrome increase risk for HCC

HONOLULU — Researchers from Penn State Milton S. Hershey Medical Center found that diabetes and metabolic syndrome were independent risk factors for the development of hepatocellular carcinoma, according to data presented during a plenary session at ACG 2015.

Among patients with diabetes, metformin and cholesterol medications were significantly protective against HCC, while insulin represented an increased risk of developing HCC when compared to diabetes alone. Sulfonylureas had no significant effect on HCC risk. Read more

7. OS comparable between Dovitinib, Nexavar for advanced HCC

The overall survival and safety rates were similar between patients with advanced hepatocellular carcinoma treated with Dovitinib vs. Nexavar, according to published findings.

“Although sorafenib has shown to improve overall survival and radiological time-to-tumor progression in Asian-Pacific patients with advanced HCC (median OS, 6.5 months; median time to tumor progression, 2.8 months), better systemic therapy remains an unmet need for patients with HCC in the Asia-Pacific region,” Ann-Lii Cheng, MD, PhD, of the National Taiwan University Hospital and National Taiwan University Cancer Center, and colleagues wrote. Read more

8. Nintedanib shows promise for treatment of HCC

Nintedanib, a triple angiokinase inhibitor, was found to be safe for treating patients with hepatocellular carcinoma and mild or moderate liver impairment, according to data from a phase 1 trial presented at the European Society for Medical Oncology’s European Cancer Congress.

“The [adverse events] profile of nintedanib was similar in patients previously treated with sorafenib,” Masafumi Ikeda, MD, chief of the department of hepatobiliary and pancreatic oncology, National Cancer Center Hospital East, Kashiwa, Japan, and researchers wrote. Read more

9. US veterans have increased frequency of HCC at autopsy

United States military veterans had an increased frequency of hepatocellular carcinoma at autopsy compared with the general population, according to findings published in Clinical Gastroenterology and Hepatology.

“Significant risk factors identified were chronic hepatitis C and liver cirrhosis,” Aqsa Nasir, MD, in the department of pathology and laboratory medicine at the University of Minnesota School of Medicine, told Healio.com/Hepatology. Read more

10. Baraclude therapy for HBV leads to lower than expected HCC incidence

Patients with hepatitis B virus infection treated with Baraclude had an unexpected lower incidence of hepatocellular carcinoma over time, although the risk for hepatocellular carcinoma in this patient population still persisted, according to the results of a retrospective study.

“In this ‘real-world’ study of a large number of U.S. patients, treatment with [entecavir] was associated with a 64% lower observed than expected HCC incidence in [patients with chronic hepatitis B] without cirrhosis,” Joseph Ahn, MD, MS, AGAF, FACG, of the division of gastroenterology and hepatology, Oregon Health and Science University, and colleagues wrote. Read more