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Non-Immunotherapy Options for the First-Line Management of Hepatocellular Carcinoma: Exploring the Evolving Role of Sorafenib and Lenvatinib in Advanced Disease
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Current Locoregional Therapies and Treatment Strategies in Hepatocellular Carcinoma
Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
Review

Role of Immunotherapy in the Management of Hepatocellular Carcinoma: Current Standards and Future Directions

Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University, 55131 Mainz, Germany
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Curr. Oncol. 2020, 27(s3), 152-164; https://doi.org/10.3747/co.27.7315
Received: 6 August 2020 / Revised: 7 September 2020 / Accepted: 8 October 2020 / Published: 1 November 2020
The multikinase inhibitor sorafenib was the only approved systemic therapy in advanced hepatocellular carcinoma (HCC) for about a decade. In recent years, the number of approved agents has increased significantly as a result of a number of positive phase iii clinical trials. Lenvatinib as a first-line treatment, and regorafenib, cabozantinib, and ramucirumab in the second-line setting are now approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency. In phase II studies, immunotherapy with nivolumab and monotherapy using pembrolizumab yielded impressive results for overall survival in therapy-naïve and pretreated patients, leading to the accelerated approval by the FDA of nivolumab and pembrolizumab for second-line treatment. However, phase III trials of nivolumab in the first line and pembrolizumab in the second line as single agents failed to reach statistical significance, although clinical benefit for a subset of patients with long durations of response could be demonstrated. Despite that setback, immunotherapy for HCC is a promising therapeutic approach, and the combination of immunotherapy with other treatment modalities such as monoclonal antibodies, tyrosine kinase inhibitors, or local therapies has the potential to increase the overall response rate and survival. Recently, the results of a phase III trial of combination atezolizumab–bevacizumab compared with sorafenib showed a highly significant survival benefit and median overall survival that was not reached in the immunotherapy arm, making the combination the preferred standard of care in first-line therapy. Despite the impressive results and generally good toxicity profile of immunotherapy, patients who respond to therapy constitute only a subset of the overall population, and response rates are still limited. This review focuses on the currently reported results and ongoing clinical trials of checkpoint inhibitor–based immunotherapy in HCC.
Keywords: hepatocellular carcinoma; immunotherapy; checkpoint inhibitors; nivolumab; pembrolizumab; durvalumab; tremelimumab; ipilimumab hepatocellular carcinoma; immunotherapy; checkpoint inhibitors; nivolumab; pembrolizumab; durvalumab; tremelimumab; ipilimumab
MDPI and ACS Style

Weinmann, A.; Galle, P.R. Role of Immunotherapy in the Management of Hepatocellular Carcinoma: Current Standards and Future Directions. Curr. Oncol. 2020, 27, 152-164. https://doi.org/10.3747/co.27.7315

AMA Style

Weinmann A, Galle PR. Role of Immunotherapy in the Management of Hepatocellular Carcinoma: Current Standards and Future Directions. Current Oncology. 2020; 27(s3):152-164. https://doi.org/10.3747/co.27.7315

Chicago/Turabian Style

Weinmann, A., and P. R. Galle. 2020. "Role of Immunotherapy in the Management of Hepatocellular Carcinoma: Current Standards and Future Directions" Current Oncology 27, no. s3: 152-164. https://doi.org/10.3747/co.27.7315

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