Interview with Professor Josep Maria Llovet of Tisch Cancer Research Institute, Mount Sinai Medical College, New York
Editor's note: Immunotherapy is a new tumor treatment method following traditional surgery, chemotherapy, radiotherapy and targeted therapy. Tumor immunotherapy represented by immunocheckpoint inhibitor (ICI) has made breakthrough in clinical practice. With the wide application of ICI in clinical practice, the exploration of biomarkers for the efficacy and prognosis prediction of immunotherapy has become a hot spot in tumor immunotherapy research. For this reason, this journal invited Professor Josep Maria Llovet from the Department of Hepatology, Clinical Hospital of the University of Barcelona, Spain, and Tisch Cancer Research Institute, Mount Sinai Medical College, New York, USA, to give an exclusive interview, focusing on the research progress of immunotherapy efficacy and prognostic biomarkers, as well as how to guide clinical decision-making and the selection of treatment plans.
iHepatology: Clinically, different liver cancer patients have different responses to immunotherapy. What factors are related to immunotherapy response?
Dr Llovet: I am Dr Josep Maria Llovet. I am Professor of Medicine, Director of Mt Sinai Liver Cancer Program in New York, and Professor of Medicine at the University of Barcelona.
iHepatology: Which biomarkers related to immunotherapy response are known to be used to screen patients suitable for immunotherapy?
Dr Llovet: At this point, we are trying to figure that out with several studies exploring biomarkers. What we want to identify is what we call ‘hot’ tumors - tumors with T-cell infiltration, cytolytic activity and showing interferon gamma signaling - as these are the ones that respond to checkpoint inhibitors. At this point, there are no biomarkers approved. This is still an area of research.
iHepatology: What treatment options can be tried for patients with poor immune response?
Dr Llovet: The first treatment is atezolizumab/bevacizumab as frontline. Also, with the HIMALAYA data, we know that durvalumab/tremelimumab is another combination that is effective. The trial results show a significant difference in terms of overall survival compared to sorafenib. And then in China there are several trials that have already provided some positive data with sintilimab plus a bevacizumab biosimilar showing superiority to sorafenib. That has been approved there. I recall that at ESMO there were two trials, one with camrelizumab with a TKI that was also superior to sorafenib, and then there is a single checkpoint inhibitor showing non-inferiority to sorafenib as well.
iHepatology: Is the earlier immunotherapy is used, the better the curative effect of HCC patients? For example, for small HCC with venous tumor thrombus, in order to prevent tumor metastasis and recurrence, can immunotherapy reduce the risk of metastasis and recurrence? Are there any relevant clinical studies?
Dr Llovet: This is still under the setting of randomized controlled clinical trials. There are five randomized controlled trials assessing immunotherapy after resection. There are also smaller early trials (phase I and II) in the neoadjuvant setting prior to resection. But the data have not been released so we don’t know if these approaches are effective.
评论
发表评论