by Dr. C.H. Weaver M.D. 6/2020
The United States Food and Drug Administration (FDA) approved the PD-L1 immune checkpoint inhibitor Tecentriq (atezolizumab) for the initial treatment of unresectable or metastatic liver cancer, in combination with Avastin (bevacizumab), an inhibitor of the VEGF receptor in May 2020. Tecentriq in combination with Avastin is the first cancer immunotherapy regimen approved for the treatment of liver cancer and represents a new standard first line treatment. (1,4)
About Hepatocellular Carcinoma (HCC)
The liver is the largest organ in the body and is responsible for over 500 functions, including the secretion of glucose, proteins, vitamins, and fats; the production of bile; the processing of hemoglobin; and detoxification of numerous substances. Liver cancer, or hepatocellular carcinoma (HCC), is the second most common cause of cancer-related deaths worldwide. Factors that increase the risk of developing hepatocellular carcinoma include cirrhosis, long-term, heavy alcohol use, and chronic infection with hepatitis B or C viruses. (2,3)
About Tecentriq ® (atezolizumab)
Tecentriq is a precision cancer immunotherapy monoclonal antibody designed to bind with a protein called PD-L1. When Tecentriq binds to PD-L1 expressed on tumor cells and tumor-infiltrating immune cells, it blocks interactions with both PD-1 and B7.1 receptors. By inhibiting PD-L1, Tecentriq may enable the re-activation of T cells. Tecentriq belongs to a class of medicines know as "checkpoint inhibitors"
About the IMbrave150 study
IMbrave150 is a global Phase III, multicenter, open-label study of 501 people with previously untreated unresectable or metastatic HCC who were treated with either the combination of Tecentriq and Avastin or Nexavar (sorafenib) and directly compared. Three times as many patients responded to treatment with Tecentriq-Avastin and these patients survived an average of 6.8 months without cancer progression compared to 4.3 months for Nexavar treated patients.
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Single agent immunotherapy has not been very effective in treating HCC. Other checkpoint inhibitors such as Keytruda and Opdivo when used as single agents have been relatively ineffective. Combining the checkpoint inhibitor Tecentriq with the VEGF inhibitor Avastin however has led to significant improvement in treatment which replaces Nexavar and other kinase inhibitors as first line therapy. Apparently Avastin makes checkpoint inhibitors work better. The combination of Tecentriq and Avastin improved the average overall survival from 13 months with Nexavar to 24 months with the combination. Perhaps even more importantly the combination also improved quality of life compared to Nexavar.
IMbrave150 is the first Phase III cancer immunotherapy study to show an improvement in survival for patients with unresectable or metastatic HCC compared with Nexavar and patients should discuss this treatment option as well as well as several other novel treatments for liver cancer with their doctor.
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- New England Journal of Medicine on May 14, 2020.
- Gastrointestinal Cancers Symposium (GICS) 2018. Abstract 206, presented January 19, 2018.
- Organization. Cancer. Available here. Last accessed: April 2017.
- FDA approves atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma