SURGERY IS A STANDARD OF CARE for patients with liver cancer. Once they’re wheeled out of surgery, however, the waiting game begins.
Currently, there are no post-surgery therapies that help prevent recurrence in patients with hepatocellular carcinoma (HCC), the most common form of liver cancer, according to Pierce Chow, a senior consultant surgeon at the National Cancer Centre Singapore. Patients’ only option is to actively monitor for any sign the disease has returned—a highly likely scenario, as the five-year recurrence rate exceeds 60%.
“As a surgeon, I see a lot of patients that are coming back after surgical resection that are really demoralized that there is no treatment for them that can prevent recurrence,” Chow said.
That reality might be changing after a new study found a drug combination administered following surgery increased the chances of keeping cancer at bay.
Chow, the study’s lead author, presented the results April 16 at the American Association for Cancer Research (AACR) Annual Meeting 2023 in Orlando, Florida. (The AACR publishes Cancer Today.)
The phase III clinical trial involved 668 liver cancer patients at high risk of recurrence after undergoing surgery or ablation, a less invasive procedure that destroys cancer cells using heat or cold administered via a needle or a probe. They were randomly assigned to either receive one year of treatment with the immune checkpoint inhibitor Tecentriq (atezolizumab) and the targeted therapy Avastin (bevacizumab) or undergo active surveillance. For participants randomized to active surveillance, if their cancer returned, they could switch to the experimental group following a second surgery or ablation.
After 12 months, 78% of patients receiving the drugs had no recurrence compared with 65% of those in active surveillance, and at 17.4 months, data showed a 28% reduced risk of recurrence for those taking the combination. “The benefit for atezolizumab and bevacizumab was consistent across all clinical groups,” Chow said.
Chow noted longer follow-up is needed to gauge the combination’s impact on overall survival.
The treatment was generally well tolerated, with side effects similar to those seen in a prior trial where the same drug regimen was given for an average of seven months to liver cancer patients ineligible for surgery, according to Chow. “In spite of the much longer treatment duration, we did not, however, see any increase in the adverse events,” he said.
In addition to potentially changing treatment for patients who have undergone surgery, the study results could influence decisions on whether or not to have surgery in the first place, according to Chow. Surgery typically is not offered if doctors believe the cancer will quickly return, but having this therapy available could make more people eligible for surgery.
Chow said the results can give patients hope for better recurrence-free survival—filling a previously unmet need. “Atezolizumab plus bevacizumab may be a practice-changing treatment option for patients at high risk of recurrence of HCC,” he said.
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