The price and value of therapeutic synergy in liver cancer
Mené dans 13 pays sur 543 patients atteints d'un carcinome hépatocellulaire non résécable (durée médiane de suivi : 7,8 mois), cet essai de phase III compare l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité du sorafénib et d'un traitement de première ligne combinant camrélizumab et rivocéranib
Over the past 5 years, breakthroughs in the delivery of systemic therapy have transformed advanced hepatocellular carcinoma, a disease with a typical life expectancy of 6 months following diagnosis, into an oncological indication in which more effective therapies and optimal sequencing have extended patients' survival to contemporary estimates ranging from 16 to 22 months in randomised trials and in routine practice. Although PD-1 pathway inhibition did not show superior efficacy over sorafenib, its use in combination with VEGF and CTLA-4 inhibitors has led to the approval of novel standards of care in advanced disease, making long-term survival an achievable aim in some patients. The capacity to selectively inhibit multiple oncogenic pathways involved in hepatocellular carcinoma progression, paired with shown monotherapy activity and convenient oral administration, has made tyrosine-kinase inhibitors (TKIs) a rational choice as combination partner for immunotherapy. However, unlike renal cell carcinoma, in which TKI doublet and triplet combinations have led to greater and more durable benefit compared with TKI monotherapy or immune-checkpoint inhibitors (ICIs), the optimal TKI combination partner has not yet emerged in advanced hepatocellular carcinoma.
The Lancet , commentaire, 2022