Camrelizumab: an investigational agent for hepatocellular carcinoma

ABSTRACT

Introduction

Although many approaches have been used to treat hepatocellular carcinoma (HCC), the clinical benefits were limited, particularly for advanced HCC. However, recent treatments with PD-1/PD-L1 inhibitor monotherapy and its combination with other therapies, have demonstrated remarkable results. Camrelizumab, a selective, humanized, high-affinity IgG4 PD-1 monoclonal antibody, has been approved as a second-line treatment in patients with advanced HCC by NMPA in China.

Areas covered

This paper introduces anti-PD-1/PD-L1 immunotherapies for advanced HCC and progresses to discuss the pharmacology, safety, and efficacy of camrelizumab in the treatment of advanced HCC. It also considers future research directions for camrelizumab in this setting.

Expert opinion

The PD-1 binding epitope of camrelizumab is different from other PD-1 inhibitors. The IC₅₀ and EC₅₀ of camrelizumab for inhibiting the binding of PD-1 and PD-L1 is similar to pembrolizumab, is significantly lower than other PD-1 inhibitors, and has a higher affinity for PD-1 site. Camrelizumab exhibits a promising antitumor activity and an acceptable safety profile similar to other PD-1 inhibitors in advanced HCC. Apatinib (a VEGFR-2 tyrosine kinase inhibitor) can reduce the incidence of camrelizumab-specific reactive cutaneous capillary endothelial proliferation (RCCEP).

KEYWORDS:

• Camrelizumab
• immune checkpoint inhibitor
• immunotherapy
• hepatocellular carcinoma

Article highlights

• Clinical trials are evaluating camrelizumab monotherapy, immunotherapy plus targeted therapies, immune checkpoint inhibitors plus systemic chemotherapy, and clinical benefit of continued immunotherapy treatments.

• Future research will focus on the recognition and development of reliable biomarkers that respond to camrelizumab in advanced HCC.

Acknowledgments

The author thanks Ying Sun (a medical science manager at Jiangsu Hengrui Pharmaceuticals Co., Ltd.) for valuable support in gathering and summarizing pre-clinical and clinical data, and Yu Tian (a medical writer at Jiangsu Hengrui Pharmaceuticals Co., Ltd.) and Yunjie Yu (a former employee of Jiangsu Hengrui Pharmaceuticals Co., Ltd.) for providing medical writing support.

Declaration of interest

Hui Chuan Sun received honorarium and lecture fees from Roche, Bayer, MSD, Eisai, Hengrui, Innovent, TopAlliance, Abbott, Beigene, Gilead, Zelgen during the last 5 years.

The 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded