Tislelizumab's inclusion in the National Comprehensive Cancer Network (NCCN) guidelines for hepatocellular carcinoma (HCC) as a category 1 recommendation marks an advancement in the treatment landscape for HCC.
Alan P. Venook, MD
Identifying a biomarker to predict which patients with hepatocellular carcinoma (HCC) are most likely to respond to checkpoint inhibitor therapy is a necessary next step in the field especially as the addition of tislelizumab-jsgr (Tevimbra) to the NCCN Clinical Practice Guidelines in Oncology for HCC as a category 1 other recommended regimen provided another checkpoint inhibitor option, according to Alan P. Venook, MD.
“[Within gastrointestinal cancers], the changes have mostly been in HCC, and the evolution of different combinations of biologics and immunotherapies have made their way to the top of the heap,” Venook, a member of the HCC NCCN guideline panel, said of the 2024 guideline changes in an interview with OncLive. “I can’t emphasize enough how these are living documents and how rapidly they can change. Our goal is to stay on top of it and stay ahead.”
In an interview with OncLive, Venook highlighted notable NCCN guideline updates in HCC from 2024 as well as next steps in the field, and considerations when implementing the changes into practice. He is the Madden Family Distinguished Professorship in Medical Oncology and Translational Research at UCSF, the Shorenstein Associate Director for Program Development at the Helen Diller Family Comprehensive Cancer Center, and a professor in the Department of Medicine at UCSF in San Francisco, California.
“HCC is evolving so rapidly,” he said. Another update to the guidelines will be made public in 2025, but the latest version added tislelizumab as a category 1 recommendation along with other regimens as a first-line systemic therapy. The update was made based on a study that compared tislelizumab with sorafenib with tislelizumab having an advantage in objective response rate.
However, it’s unclear if the many agents approved to treat HCC are different from one another or making advances against the disease.
“Distinguishing one from the other is impossible and it is likely that these [agents] will never be compared head-to-head because they are [manufactured by] different companies that have the indication from different study designs and it’s not clear that they want to put their drugs up against each other,” Venook said.
The flaw with current HCC studies is that they usually evaluate median survival outcomes, and “it’s not clear that these treatments make a difference because many patients get no benefit at all.” There are a subset of patients who do benefit, and the end points have to assess the patients who don’t progress at a certain period of time.
He reminded community oncologists that it’s key to keep downloading the latest versions of the guidelines, because they are living documents that get updated regularly.
Read the full interview at OncLive.
Reference
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