Current Treatment Landscape for Advanced Hepatocellular Carcinoma: Patient Outcomes and the Impact on Quality of Life

Abstract

Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer mortality worldwide. Heterogeneity of clinical conditions contributes to the complex management of care for patients with advanced HCC. Recently, the treatment landscape for advanced HCC has expanded rapidly, with the additional FDA approvals of several oral tyrosine kinase inhibitors (lenvatinib, regorafenib, and cabozantinib), as well as immunotherapies such as immune check point inhibitors (nivolumab and pembrolizumab) and the monoclonal IgG1 antibody, ramucirumab. This expansion has generated a need for novel treatment sequencing strategies in this patient population. In light of these developments, an evaluation of the impact of FDA-approved therapeutics on patient-centered outcomes such as health-related quality of life (HRQoL) is warranted. An increased understanding of HRQoL in patients included in advanced HCC clinical trials could potentially help physician decision-making for treatment sequencing in patients with advanced HCC.

<p>Development and Validation of a Novel 8 Immune Gene Prognostic Signature Based on the Immune Expression Profile for Hepatocellular Carcinoma</p>

“…HCC is a highly aggressive malignancy and is currently the second leading cause of tumor-related death. 1 Despite plenty of advances in comprehensive treatment strategies for hepatocellular carcinoma, effective molecular targeted therapies are still lacking. 23 The complex immune microenvironment promotes the development of HCC and mediates the poor prognosis of patients.…”

“…Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related mortality and the fifth most common malignancy worldwide. 1 In 2012, it was estimated that approximately 700,000 people globally die of hepatocellular carcinoma each year. 2 The incidence of HCC varies by geographic region, gender, age, and risk factors associated with cancer development.…”

A Competing-Risk Nomogram Predicting Second Primary Malignancy in Hepatocellular Carcinoma Survivors

“…For instance, ablation was recommended as first-line radical treatment for small HCCs as curative treatment modalities [19]. In 2007, Sorafenib, an oral multitargeted kinase inhibitor, was approved as the first-line treatment for advanced HCC officially [20]. Since then, other targeted therapy and immune checkpoint inhibitors were also applied in clinical practice.…”

Overshadowed prospect of programmed cell death protein-1 (PD-1) inhibitor as monotherapy for patients with advanced hepatocellular carcinoma

“…Surgical removal of the tumor is associated with better cancer prognosis, but only 10-15% of patients are suitable for surgical resection due to the extent of disease or poor liver function (3,4). For more advanced disease, including spread of cancer beyond the liver or in persons who may not tolerate surgery, molecular targeted drugs including sorafenib, lenvatinib, regorafenib, and cabozantinib might be employed to decrease symptoms of disease and maximize duration of survival (5). Two programmed cell death protein-1 (PD-1) inhibitors, nivolumab and pembrolizumab, have received accelerated approval for HCC treatment based on the promising results of phase 1/2 clinical trials.…”

“…Two programmed cell death protein-1 (PD-1) inhibitors, nivolumab and pembrolizumab, have received accelerated approval for HCC treatment based on the promising results of phase 1/2 clinical trials. However, the recently disclosed outcomes of phase 3 clinical trials of both drugs might overshadow the application of PD-1 inhibitors as monotherapy in advanced HCC patients (5)(6)(7).…”