The 2024 update to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for Hepatocellular Carcinoma (HCC) includes tislelizumab-jsgr (Tevimbra) as a category 1 recommended regimen for first-line systemic therapy. This update, based on studies demonstrating an advantage in objective response rate compared to sorafenib, provides another checkpoint inhibitor option for treating HCC.
Evolving Treatment Landscape in HCC
According to Alan P. Venook, MD, a member of the HCC NCCN guideline panel, the field of HCC treatment is rapidly evolving with new combinations of biologics and immunotherapies. He emphasized that the NCCN guidelines are "living documents" that are updated frequently to reflect the latest research and clinical data. The guidelines aim to provide practitioners with timely and up-to-date recommendations for managing HCC.
Key Updates in the 2024 NCCN Guidelines
Besides the addition of tislelizumab, the 2024 NCCN guidelines for HCC include several other notable revisions:
- Repotrectinib (Augtyro) was added under useful in certain circumstances (category 2B) for NTRK gene-fusion positive tumors.
- Nivolumab (Opdivo), atezolizumab (Tecentriq) plus bevacizumab (Avastin), and nivolumab plus ipilimumab (Yervoy; for tumor mutational burden high tumors) were removed from useful in certain circumstances regimens for first-line systemic therapy.
- Nivolumab plus ipilimumab (for tumor mutational burden-high tumors) was also removed from useful in certain circumstances regimens for subsequent-line systemic therapy if disease progression occurred.
Challenges and Future Directions
Despite the increasing number of approved agents for HCC, it remains unclear whether these treatments offer distinct advantages over one another. Dr. Venook noted that head-to-head comparisons between different agents are unlikely due to various factors, including different company interests and study designs. He also pointed out that many HCC studies focus on median survival outcomes, which may not accurately reflect the benefits experienced by a subset of patients.
A significant challenge in HCC treatment is the lack of reliable biomarkers to predict which patients are most likely to respond to checkpoint inhibitors. While some patients experience significant benefits from these therapies, others do not. Future research should focus on identifying biomarkers that can help clinicians select the most appropriate treatment for each patient.
Staying Current with NCCN Guidelines
Dr. Venook stressed the importance of community oncologists regularly downloading the latest versions of the NCCN guidelines. Given the rapid pace of advancements in HCC treatment, guidelines are updated frequently to incorporate new data and recommendations. By staying current with the latest guidelines, practitioners can ensure that they are providing the best possible care for their patients.
