Sorafenib, a tyrosine kinase inhibitor, has been unbeatable for treating cancer of the liver for the past thirteen years. An article by the Cleveland Clinic stated that during that time, no other form of medication has been proven to be more effective. That is until now. Yet it was not for lack of trying.

About Hepatocellular Carcinoma (HCC)

Although HCC is a common form of liver cancer, it is perhaps the most deadly. The FDA recently approved the combination of atezolizumab and bevacizumab to treat newly diagnosed HCC patients. The announcement followed a report on the results of phase three IMbrave-150 clinical trial published in NEJM. Study results indicate that survival rates using the new drug were superior to sorafenib.

About the HCC Study

Three hundred thirty-six patients were treated intravenously. The infusions were followed by an antibody called bevacizumab, which targets vascular endothelial growth factor (VEGF). It is to be administered at three-week intervals. In the new cohorts (groups), one hundred and sixty-five patients were treated with oral sorafenib.

Dr. Bassam Estfan is a Cleveland Clinic gastrointestinal oncologist who agrees with the rationale of combining the two agents. He noted that inhibiting only one pathway can lead to a change in a cell, but attacking both pathways simultaneously has improved not only responses but also life expectancy.

About the Primary Analysis

Results of the combined treatment compared with sorafenib were encouraging.

• A forty-two percent reduction in risk of death
• The twelve-month overall survival was sixty-seven percent and fifty-four percent with sorafenib
• Progression-free survival (PFS) was approximately seven months compared to four months with sorafenib
• At the six month mark, the combination averaged a PFS rate of fifty-four percent versus thirty-seven percent for sorafenib

The study also revealed that patients who received the new combination experienced a better quality of life as opposed to patients receiving sorafenib. Fewer adverse events were reported with the new combination. However, fifteen percent of patients receiving the combination therapy reported grade three or four hypertension.

Dr. Estfan concluded by saying that this is the first time in a decade that a therapy regimen proved to be superior to sorafenib. He commented that it is very encouraging.