Advanced hepatocellular carcinoma and personalised therapy
Dr Ghassan Abou-Alfa - Memorial Sloan Kettering Cancer Center, New York, USA
The other sector that really we are very interested at the moment in is immuno-oncology, like everywhere else. Checkpoint inhibitors are really becoming more of interest and better understood in that space. We know of data already that’s been reported by many investigators in regard to the combination of anti-PD-L1 plus anti-CTLA4 or anti-PD-L1 alone or anti-CTLA4 alone. A couple of studies are still ongoing, one of them is we have a trial in progress poster at ASCO this year which is looking at the combination of anti-PD-L1 plus anti-CTLA4, treme plus medi, from MedImmune/AstraZeneca versus treme versus medi. This definitely is going to bring in a lot of wealth in regard to the information that comes along from that perspective.
Other studies are worth noting, despite they are not necessarily being a trial in progress at ASCO but there is a very critical study that’s based on Anthony El-Khoueiry’s data on nivolumab in the HCC arena that showed a quite impressive response rate and with suggestions also for improvement in outcome. There’s currently a phase III trial of nivolumab versus sorafenib in HCC that no doubt everybody is waiting for the results of.
There’s also something coming up this year about Pexa-Vec against sorafenib. Have you seen anything coming out of that?
Pexa-Vec is again a trial in progress study. This is a very complex but fascinating area of interest in oncology and in HCC specifically. This is a vaccinia virus which is an altered smallpox virus that actually has embedded in it an altered mechanism of tyrosine kinase that normal cells will not react to but it can disrupt cancer cells and at the same time replicate and destroy further cells. Data in the past have shown that at a certain number or amount of vaccine units or virus units you can actually show an improvement in outcome compared to a lower unit of viral load. With this said, a trial has evolved from a certain understanding of the mechanism of interaction between sorafenib and Pexa-Vec and as such the current randomised trial is looking at sorafenib as a single agent, which is the standard of care, versus Pexa-Vec and sorafenib in combination.
Another story that is evolving that we don’t have the results of yet, and this hopefully will come very soon, is regorafenib in the second line setting. This is a study that looked at regorafenib, which is a multi-kinase inhibitor, the same like sorafenib, in the second line setting after failing sorafenib. That’s quite fascinating because this data, at least by press release, is reported to be positive. We don’t know the results of the data yet but no question is very intriguing because that space of the second line setting has rather failed unfortunately with many very genuine attempts with different therapies with different targets. However, it’s quite fascinating to see that a multi-kinase of the same family of sorafenib is successful in the second line setting. This is a story definitely highly recommended to follow once it has come out.