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Systemic Treatment for Older Patients with Unresectable Hepatocellular Carcinoma

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Abstract

The incidence rate of hepatocellular carcinoma is growing and age at diagnosis is increasing; however, despite the unprecedented wealth of therapeutic options for advanced HCC, its optimal management in some categories, such as older adults, is yet to be defined. Even though age is not an exclusion criterion per se, most of the landmark trials enrolled a limited number of senior patients, raising some concerns on the potential benefit of active treatments in this group. The identification of more vulnerable patients remains a crucial issue in clinical practice. In fact, the suitability assessment for systemic therapy through performance status metrics might underestimate or conversely overestimate the fitness of older patients, failing to detect other relevant impairments. Thus, the assessment of frailty through geriatric screening scales is largely necessary. In addition, most of the available data relate to the use of sorafenib, while very little is known about the most recent therapeutic agents. Age subgroup analyses provided by many of the pivotal trials did not find significant efficacy or safety differences across ages; however, the most widely used cut-off age of 65 years may not be very informative for the current older population. Regarding immunotherapy, the clinical benefit reported with immune checkpoint inhibitors reassures their safe use in senior patients and supports further investigations to assess their efficacy in this population.

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Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy

    Antonella Cammarota, Antonio D’Alessio, Lorenza Rimassa & Nicola Personeni

  2. Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy

    Antonella Cammarota, Antonio D’Alessio, Tiziana Pressiani, Lorenza Rimassa & Nicola Personeni

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  1. Antonella Cammarota
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Correspondence to Lorenza Rimassa.

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No sources of funding were used to conduct this study or prepare this manuscript. No writing assistance was utilized in the production of this manuscript.

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Tiziana Pressiani received consulting fees from Bayer, as well as institutional research funding from Bayer, Lilly, and Roche. Lorenza Rimassa received consulting fees from Amgen, ArQule, AstraZeneca, Basilea, Bayer, BMS, Celgene, Eisai, Exelixis, Genenta, Hengrui, Incyte, Ipsen, IQVIA, Lilly, MSD, Nerviano Medical Sciences, Roche, Sanofi, and Zymeworks; lecture fees from AbbVie, Amgen, Bayer, Eisai, Gilead, Incyte, Ipsen, Lilly, Merck Serono, Roche, and Sanofi; travel expenses from Ipsen; and institutional research funding from Agios, ARMO BioSciences, AstraZeneca, BeiGene, Eisai, Exelixis, Fibrogen, Incyte, Ipsen, Lilly, MSD, Nerviano Medical Sciences, Roche, and Zymeworks. Nicola Personeni received consulting fees from Amgen, Merck Serono, and Servier; lectures fees from AbbVie, Gilead, Lilly, and Sanofi; travel expenses from Amgen, and ArQule; and institutional research funding from Basilea, Merck Serono, and Servier. All authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Cammarota, A., D’Alessio, A., Pressiani, T. et al. Systemic Treatment for Older Patients with Unresectable Hepatocellular Carcinoma. Drugs Aging 38, 579–591 (2021). https://doi.org/10.1007/s40266-021-00871-5

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