Medical treatment of advanced hepatocellular carcinoma patients: the issue is not the right drug, but the right patient

Abstract

On July 5^th, 2018, the final results of the CELESTIAL trial were published on the authoritative pages of the New England Journal of Medicine (1); in this placebo‐controlled, phase III trial, previously treated patients with advanced hepatocellular carcinoma (HCC) were randomized in a 2 to 1 fashion to receive either the multikinase inhibitor Cabozantinib (targeting, among the others, Vascular Endothelial Growth Factor Receptors [VEGFRs], MET, and AXL), or placebo. The study succeeded in demonstrating a reduction in the risk of death of 24% in favor of Cabozantinib; indeed, median overall survival (OS) was 10.2 months with Cabozantinib and 8.0 months with placebo (Hazard Ratio [HR] = 0.76, 95% confidence interval [CI] = 0.63 to 0.92, p=0.005) (1).

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