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ICI monotherapy or combination: ESMO update

邵幼雲

2020 Nov 17

Among immune checkpoint inhibitors, PD-1 blockade has been proven effective as
salvage therapy for patients with advanced hepatocellular carcinoma (HCC). The
objective response rate of anti-PD1 antibodies, nivolumab and pembrolizumab, was
approximately 17%, the response could be durable. Although effective and with a good

safety profile, such a result may not be good enough as first-line therapy for advanced
HCC if these inhibitors were used alone. Combining PD-1 blockade with either
antiangiogenic targeted therapy of other checkpoint inhibitors such as anti-CTLA4
antibodies is under active investigation. Among combination with antiangiogenic

targeted therapy, bevacizumab with atezolizumab has been demonstrated in a phase 3
clinical trial to provided better survival benefits than sorafenib. Similar combinations,
such as lenvatinib and pembrolizumab or apatinib and camrelizumab, are being
explored in phase 3 trials. Referring to combination of PD-1 blockade and anti-CTLA4

antibodies, nivolumab with ipilimumab was shown to provide a response rate of
approximately 32% in patients who failed previous sorafenib treatment. A similar
combination with durvalumab and tremelimumab also showed an increased response
rate. Both regimens were explored as first-line therapy in phase 3 clinical trials. Above

all, although single agent PD-1 blockade is not effective enough as the standard
first-line therapy for advanced HCC, its combination with either antiangiogenic
targeted therapy or anti-CTLA4 antibodies showed promise.