Cancer Treatment Today

Nexavar is FDA approved for hepatocellular carcinoma as a single agent. Tarceva is a targeted anticancer drug that works by blocking a biological pathway referred to as the epidermal growth factor receptor (EGFR) pathway. The EGFR pathway is involved in cell growth and replication and when mutated or altered, excessive replication of cells can occur. Tarceva has been shown to improve treatment outcomes in selected patients with advanced non–small cell lung cancer or pancreatic cancer, and is also being evaluated in the treatment of other types of cancer. A recent phase II study suggested that it is effective with Nexavar for liver cancer. Tarceva alone is still in trials. Several have been completed and not reported; one is ongoing: Erlotinib in Treating Patients With Unresectable Liver, Bile Duct, or Gallbladder Cancer, NCT00033462. There are in total two phase II trials that support Tarceva.

However, for the combination there are still ongoing trials. There are clinical trials evaluating TKIs for HCC, including those tested in combination with (eg, erlotinib) or compared with (eg, linifanib) sorafenib as a first-line therapy. For patients who do not respond or are intolerant to sorafenib, TKIs such as brivanib, everolimus, and monoclonal antibodies (eg, ramucirumab) are also being tested as second-line therapies. There are early stage trials investigating the efficacy for up to 60 reagents for HCC. There is no literature or guidelines that support this combination, or any treatment in third line for HCC. TheS EARCH: Randomized phase III trial of sorafenib versus placebo in patients with advanced hepatocellular carcinoma (HCC) by Lovett et al is eagerly awaited but has not yet been published.

Augusto Villanueva et al, Targeted Therapies for Hepatocellular Carcinoma, Gastroenterology
Volume 140, Issue 5 , Pages 1410-1426, May 2011

Philip P, Mahoney M, Allmer C, et al. Phase II Study of Erlotinib (OSI-774) in Patients With Advanced Hepatocellular Cancer. Journal of Clinical Oncology. 2005; 23: 6657-6663.

Thomas MB, Morris JS, Chadha R et al. Phase II trial of the combination of bevacizumab and erlotinib in patients who have advanced hepatocellular carcinoma. Journal of Clinical Oncology [early online publication]. January 12, 2009.

Philip P, Mahoney M, Allmer C, et al. Phase II Study of Erlotinib (OSI-774) in Patients With Advanced Hepatocellular Cancer. Journal of Clinical Oncology. 2005; 23: 6657-6663.

Thomas MB, Morris JS, Chadha R et al. Phase II trial of the combination of bevacizumab and erlotinib in patients who have advanced hepatocellular carcinoma. Journal of Clinical Oncology [early online publication]. January 12, 2009.
Thomas MB, Morris JS, Chadha R et al. Phase II trial of the combination of bevacizumab and erlotinib in patients who have advanced hepatocellular carcinoma. Journal of Clinical Oncology [early online publication]. January 12, 2009.

Philip P, Mahoney M, Allmer C, et al. Phase II Study of Erlotinib (OSI-774) in Patients With Advanced Hepatocellular Cancer. Journal of Clinical Oncology. 2005; 23: 6657-6663.