Hepatocellular carcinoma (HCC) is the most common type of liver cancer and occurs mainly in patients with underlying chronic liver disease and cirrhosis. Advanced (metastatic) HCC occurs when the cancer has spread to lymph nodes or to other organs. HCC can produce markers that can be detected by a blood test. One of the markers produced by HCC is called alpha fetoprotein (AFP). AFP level can reflect the tumour responsiveness to treatment. The cancer medicine, sorafenib is the recommended first line treatment option for HCC. However, some patients may not respond to this medicine or they may be intolerant to it and may require other treatments (second line).
Ramucirumab is being investigated in clinical trials as a second line treatment for patients with advanced HCC who have elevated baseline AFP, and also in patients who are either intolerant to sorafenib therapy or whose HCC progressed following treatment with sorafenib therapy. Ramucirumab is given as intravenous (IV) injection and acts by preventing tumour growth by slowing the formation of new blood vessels which supply the tumour cells with blood. It is already approved for the treatment of certain types of advanced cancers such as stomach cancer, colorectal cancer and non-small cell lung cancer. If licensed, ramucirumab may offer a new second line treatment option for patients with advanced HCC who have elevated baseline AFP and have not responded or are intolerant to the first line treatment.
Selinexor is the first treatment option that targets XPO1, a protein that is responsible for exporting tumour suppressor proteins from the cell nucleus. It belongs to a new family of therapies called selective inhibition of nuclear export (SINE) compounds that blocks XPO1 leading to controlled death of myeloma cells. Currently there is no standard of care for the fifth line treatment of MM. Selinexor and low-dose dexamethasone are being developed as an oral treatment. If licensed, this combination could be an effective treatment option for a patient group with clear unmet need.