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.
Triptorelin is being developed as an injection under the skin (subcutaneous) for the treatment of locally advanced or metastatic prostate cancer. It is already marketed for this condition but is given by injection deep into the muscles (intramuscular). Triptorelin is an artificial analogue of natural gonadotropin‐releasing hormone that acts to slowly reduce the level of testosterone in the body. The first administration of triptorelin stimulates an increase in testosterone levels but prolonged administration leads to a fall in plasma testosterone or oestradiol to castrate levels which is maintained for as long as the product is administered. Triptorelin as a subcutaneous injection formulation has the potential advantage of improved safety and local tolerability when compared to intramuscular injection formulation.