"We have found that many of our discoveries are helping grow the pipeline of novel diagnostics and therapeutics available to patients here and around the world,” said Mark Pimentel, MD, director of the Medically Associated Science and Technology (MAST) Program. Results released at the Gastrointestinal Cancers Symposium showed that the medication sparked a response in 16.1 percent of patients with advanced liver cancer, previously treated with Nexavar, who participated in a trial. Lenvima was more effective at prolonging progression-free survival, however, with a median 7.4 months versus 3.7 months with Nexavar. At the beginning of 2017, patients with inoperable hepatocellular carcinoma (HCC), or liver cancer, were hungry for novel treatments: It had been a decade since the targeted drug Nexavar (sorafenib) was approved by the Food and Drug Administration (FDA). Many great efforts have been done, and, unfortunately, all of them have been negative. Another TKI seems likely to be approved for the initial treatment of liver cancer, according to Abou-Alfa. A year from now, with more data in, Abou-Alfa expects that the scientific community will have more answers about whether Opdivo will best Nexavar in firstline treatment, as well as whether Imfinzi and tremelimumab, used together, will bring meaningful benefit. In the trial that led to the approval, the most common serious or severe side effects associated with Stivarga were hypertension, hand-foot skin reaction, fatigue and diarrhea. Published. As a firstline treatment, researchers are testing a combination of the checkpoint inhibitors Imfinzi (durvalumab) and tremelimumab in the HIMALAYA study. Currently, it is thought that CAR T-cell therapies aimed at liver cancer might be most effective if they target alpha-fetoprotein, but questions remain, Abou-Alfa says. Side effects occurred in 73.1 percent of patients, with fatigue and signs of liver damage seen in more than 10 percent, and serious side effects, including one death, seen in 25 percent. “We’ll see that phase 3 trial soon. PHOTO: LIANHE ZAOBAO. “This has been an incredible year and positive time regarding our therapies for (patients with) liver cancer,” says Ghassan K. Abou-Alfa, M.D., a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City. “We have been trying for the past 10 years to see how we can improve on the outcome of sorafenib by trying different things — going into combination therapies or even looking at second-line therapy. “I am very happy to see, and very proud that I am involved in, the effort with Pexa-Vec, which is being looked at as an intratumoral injection on top of sorafenib,” Abou-Alfa says of the oncolytic virus, designed to specifically target and kill liver cancer cells. © 2020 MJH Life Sciences™ and Cure Today. In 2018, Cedars-Sinai’s team of digestive and liver disease experts revealed breakthroughs in research and patient care with improved diagnostics tools and treatment protocols. While this process may initially be a protective response to wounds in the intestine caused by Crohn’s, the extra fat can eventually cause fibrosis, making the disease worse. Photo by Cedars-Sinai. After 10 years without a new drug for liver cancer, two approvals and a promising pipeline are changing the landscape. In April 2017, the FDA approved another TKI, Stivarga (regorafenib), because it was shown to improve survival compared with placebo after prior exposure to Nexavar, Abou-Alfa says. “Creeping Fat” around intestines of IBD patients: Most Crohn’s disease patients develop what is known as “creeping fat” around sites of inflammation in the intestines. Stivarga, which disables proteins that help grow the blood vessels that feed tumors, is meant to be used after Nexavar if disease progression occurs. After 10 years without a new drug for liver cancer, two approvals and a promising pipeline are changing the landscape. The answers will depend on data from ongoing clinical trials on Cabometyx, Opdivo and other drugs, he says. Nexavar was “the first systemic therapy with a survival benefit for HCC,” according to Amit G. Singal, M.D., associate professor of internal medicine and medical director of the Parkland Liver Tumor Program at University of Texas Southwestern Medical Center in Dallas. The most common serious or severe side effects were indicators of potential liver or pancreas damage. Mark Pimentel, MD, is director of the Medically Associated Science and Technology Program at Cedars-Sinai. The most common serious or severe side effects that occurred more frequently in the Cabometyx group included hand-foot skin reaction, hypertension, signs of liver damage, fatigue and diarrhea. All rights reserved. The findings suggest that FAST can be used as part of digital health apps for patients to more accurately track their food-specific gastrointestinal symptoms. It’s not yet certain whether using immunotherapies and TKIs together will improve outcomes, but the idea is on the table, Abou-Alfa says. The drug is known as a tyrosine kinase inhibitor (TKI) because it works by targeting and disabling specific cancer- driving proteins, or kinases. The overall response rate among participants was 4 percent with Cabometyx and 0.4 percent with placebo. All Rights Reserved. Apr 30, 2018, 4:59 pm SGT. By the end of the year, the oncologists’ toolbox contained two more medications that could be used after Nexavar in case of disease progression — the targeted treatment Stivarga (regorafenib) and the immunotherapy Opdivo (nivolumab). In a study of the make-up and behavior of “creeping fat,” investigators found that specific gut bacteria migrate to the fat tissue outside of the gut and stimulate that area of fat to grow. 2018: New Research and Treatments for Digestive, Liver Diseases, Initiative Created to Accelerate Drug Development, Researchers Explore Role of S-adenosylmethionine, Research Identifies Gut Gas Linked to Diarrhea, COVID-19 Update: Surge Preparedness, Vaccine Distribution, Long-Term Impacts of COVID-19: Your Mental Health, Today: The 2 Holiday Scenarios When You Should Wear a Mask at Home, Three Brothers Bond Over Shared Rare Disease, Study: TB Vaccine Linked to Lower Risk of Contracting COVID-19, Holiday Travel Tips From an Infectious Disease Specialist. In the past, the experimental drug tivantinib, which also inhibits c-MET, did not prove effective when compared with placebo in c-MET-positive patients with liver cancer. All rights reserved. Abou-Alfa describes this sequencing issue as one of his biggest challenges. “This includes advances in early diagnosis and treatment of inflammatory bowel disease (IBD) that are being fueled by new genetic research and interdisciplinary approaches to managing the disease.”. Six months out, of those initial responders, 43.1 percent continued to derive benefit from the drug and 77.9 percent had not experienced disease progression. If all or many of these drugs get approved, scientists and doctors will be left grappling with the question of which should be used as initial treatments and which in the second line.
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