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BackTable / VI / Podcast / Episode #513
Combination Therapy and Clinical Trials for Advanced HCC: What They Really Mean
with Dr. Lingling Du, Dr. Jonathan Mizrahi, Dr. Adam Burgoyne and Dr. Zach Berman
In the past five years, the use of immunotherapeutic agents for advanced cancers has emerged as a promising alternative to tyrosine kinase inhibitors and chemotherapy, making it an exciting time to be practicing oncology. In this episode, Dr. Tyler Sandow interviews oncology experts about the landscape of advanced hepatocellular carcinoma (HCC) and the current state of immunotherapy treatments. He is joined by medical oncologists Dr. Jonathan Mizrah, Dr. Lingling Du, and Dr. Adam Burgoyne, as well as interventional oncologist Dr. Zachary Berman.
Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:
https://www.cmeuniversity.com/course/take/125737
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BackTable, LLC (Producer). (2025, January 31). Ep. 513 – Combination Therapy and Clinical Trials for Advanced HCC: What They Really Mean [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Lingling Du
Dr. Lingling Du is an oncologist with Ochsner Health in New Orleans, Louisiana.
Dr. Jonathan Mizrahi
Dr. Jonathan Mizrahi is a medical oncologist with Ochsner Health in New Orleans, Louisiana.
Dr. Adam Burgoyne
Dr. Adam Burgoyne is a gastrointestinal / hepatobiliary oncologist and associate clinical professor with Ochsner Health in New Orleans, Louisiana.
Dr. Zach Berman
Dr. Zachary Berman is an interventional radiologist at the University of California San Diego in San Diego, California.
Dr. Tyler Sandow
Dr. Tyler Sandow is an interventional radiologist with Ochsner Health in New Orleans, Louisiana.
Synopsis
Drs. Burgoyne and Mizrahi provide a primer on immunotherapy and explain how they communicate the principles of this treatment to their patients. Dr. Du discusses the Imbrave clinical trial and how recent studies have shown improved overall survival when immunotherapeutic agents are used, especially when multiple agents targeting various pathways are employed. When choosing between different regimens, the doctors consider factors such as the patient's underlying liver function, symptom burden, and prior treatments.
Importantly, the doctors also discuss contraindications to immunotherapy, including a history of organ transplant, autoimmune disease, and poor performance status—all of which put patients at high risk for deterioration with this treatment. The treatment of patients with poor liver function remains controversial, as underlying cirrhosis may prevent the recovery of liver function. Dr. Berman outlines recent clinical trials studying the effects of transarterial chemoembolization (TACE) combined with immunotherapy. Finally, the doctors discuss the future of HCC treatment and the benefits of continued innovation in both interventional and medical oncology.
Timestamps
00:00 - Introduction to Immunotherapy
04:32 - Notable Clinical Trials
13:39 - HCC Etiology and Immunotherapy Outcomes
18:43 - Contraindications for Immunotherapy
23:05 - Adverse Effects from Treatment
25:14 - Combination Therapy
36:22 - Considerations for Immunotherapy Dosing
40:26 - The Future of HCC Treatment
Resources
Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma, IMbrave150 Trial (Finn et al, 2020):
https://pubmed.ncbi.nlm.nih.gov/32402160/
Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma, HIMALAYA Trial (Abou-Alfa et al, 2022):
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2100070
Nivolumab versus sorafenib in advanced hepatocellular carcinoma (CheckMate 459): a randomised, multicentre, open-label, phase 3 trial (Yau, 2022):
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00604-5/abstract
Nivolumab (NIVO) plus ipilimumab (IPI) vs lenvatinib (LEN) or sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC): First results from CheckMate 9DW (Galle, 2024):
https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA4008
Randomized Phase 3 LEAP-012 Study: Transarterial Chemoembolization With or Without Lenvatinib Plus Pembrolizumab for Intermediate-Stage Hepatocellular Carcinoma Not Amenable to Curative Treatment (Llovet, 2022):
https://pubmed.ncbi.nlm.nih.gov/35119481/
EMERALD-1: A phase 3, randomized, placebo-controlled study of transarterial chemoembolization combined with durvalumab with or without bevacizumab in participants with unresectable hepatocellular carcinoma eligible for embolization (Lencioni, 2024):
https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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