Two recent clinical trials have indicated that incorporating immunotherapy into the standard treatment regimen for hepatocellular carcinoma, the most prevalent form of liver cancer, can significantly delay disease progression. The studies, both published in The Lancet, suggest a potential shift in the standard of care for this patient population, marking the first major change in two decades.
The current standard treatment for patients with hepatocellular carcinoma that cannot be surgically removed involves transarterial chemoembolization (TACE), a procedure that delivers chemotherapy directly into the blood vessel feeding the tumor, followed by the injection of small particles to block the tumor's blood supply. Historically, the survival time following this treatment has been limited to a few months.
Emerald-1 Trial: Durvalumab and Bevacizumab
The Emerald-1 trial evaluated the combination of durvalumab, an immunotherapy, and bevacizumab, a medication that inhibits blood vessel growth, alongside TACE. The study included 616 patients with liver cancer from various locations worldwide. Results indicated that patients treated with TACE plus a placebo experienced an average delay in cancer progression of 8.2 months. In contrast, those who received durvalumab and bevacizumab in addition to TACE saw their cancer progression delayed for an average of 15 months.
Leap-012 Trial: Pembrolizumab and Lenvatinib
A similar trial, Leap-012, investigated the use of pembrolizumab, another immunotherapy, and lenvatinib, a cancer growth blocker, in conjunction with TACE. This trial involved 480 participants globally. The findings showed that the group receiving pembrolizumab and lenvatinib with TACE experienced a delay in cancer progression of 14.6 months, compared to 10 months for those treated with TACE and a placebo.
Experts from University Hospital Wurzburg in Germany commented on the Leap-012 trial, stating, "Tace plus lenvatinib plus pembrolizumab showed significant, clinically meaningful improvement in progression-free survival in patients with unresectable, non-metastatic hepatocellular carcinoma compared with Tace plus placebo."
