Liver cancer, anticipating immunotherapy reduces the risk of progression

Liver cancer, anticipating immunotherapy reduces the risk of progression

From San Francisco, where the Gastrointestinal Cancers Symposium of the American Society of Clinical Oncology (ASCO GI), encouraging results arrive to improve the treatment of liver cancer, a neoplasm which every year in Italy has more than 12 thousand diagnoses, almost all for hepatocellular carcinoma. Riccardo Lencioni of the University of Pisa has in fact presented data according to which it is possible to improve the outcomes of a classic therapy against liver cancer to reduce the risk of disease progression or death thanks to the help of immunotherapy, usually reserved for advanced stages of this tumor.

TACE is not enough

The standard therapy referred to is the so-called TACE – acronym for trans-arterial chemoebolization -, a procedure that closes the blood vessels that support tumor growth, while at the same time directly administering chemotherapy drugs or radiotherapy. It is a minimally invasive treatment, usually reserved for intermediate-stage tumors, but after therapy the disease returns or progresses within a year in many patients.

The combination with immunotherapy

However, the effectiveness of TACE can be increased if the administration of other anticancer agents is added to the treatment, in particular an immunotherapeutic agent and an agent capable of blocking the growth of new blood vessels. This is demonstrated by the results of the EMERALD-1 study, a phase III trial on 600 patients with unresectable hepatocellular carcinoma eligible for embolization. The study tested the efficacy of durvalumab (the immunotherapy) in addition to TACE, with or without bevacizumab (the antiangiogenic). “The data presented today demonstrate how a combined therapeutic approach, which includes, in addition to chemoembolization, a systemic treatment with durvalumab and bevacizumab, is able to significantly increase progression-free survival,” explained Lencini.

In detail, durvalumab plus TACE and bevacizumab reduced the risk of disease progression or death by 23% compared to TACE alone. Median progression-free survival was almost double in those who received the combination with the immunotherapy compared to TACE alone (15 months versus 8.2 months). In the study, the combination of drugs was associated with a greater number of grade 3 and 4 adverse events, although the safety profile was mostly compatible with that of the individual drugs.

Immunotherapy in earlier stages

“Immunotherapy with durvalumab has already proven to be effective in metastatic disease – he added Vincenzo Mazzaferro, Professor of Surgery at the University of Milan and Director of Oncological Surgery (hepato-gastro-pancreatic) and Liver Transplant at the IRCCS Foundation National Cancer Institute of Milan – The EMERALD-1 study highlights the important role of immunotherapy in combination with chemoembolization, when the tumor is confined to the liver and liver function is not impaired. Some of these patients may achieve levels of tumor response compatible with curative therapies such as tumor resection or transplant.”

The main risk factors for cancer are hepatitis B and hepatitis C infections, metabolic syndrome and alcohol abuse. “All patients who have developed a form of hepatitis – concludes the expert – must undergo frequent hepatological checks to monitor the progress of the infection, treat it and diagnose the possible development of liver cancer early”.

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