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Commentary: Locoregional Treatments for HCC, July 2022
Liver transplantation cures both HCC and the underlying cirrhosis; however, tumor progression while the patient is on the waiting list is an ongoing concern. Couillard and colleagues reported a retrospective study of 88 patients with HCC who underwent percutaneous microwave ablation for 141 tumors while on the liver transplant list. The median follow-up was 61 months. Seventy-one patients (80.7%) underwent liver transplantation after a median wait time of 8.5 months. No tumor seeding was identified. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) of whom because of tumor progression outside of the Milan criteria. A total of five of 71 (7.0%) patients had posttransplant recurrence of HCC and all died during this time. The 5-year overall survival (OS) following liver transplantation was 76.7% and the disease-specific survival after transplantation was 89.6%. The authors concluded that microwave ablation is a safe and effective treatment that bridges patients to successful transplantation.
Radiation segmentectomy is performed by the administration of radioactive yttrium (90Y)-bound microspheres transarterially to the segment of liver containing an unresected tumor. Kim and colleagues described the results of a prospective trial that evaluated the efficacy of radiation segmentectomy with curative intent in patients with Child-Pugh score A–B7 and small (< 3 cm), unresectable HCC, where the tumors were in a location unsuitable for ablation. Of the 44 individuals assessed for eligibility, 29 patients were included in the study. A complete response was observed in 24 (83%) patients, and a partial response was observed in 5 (17%) patients. All patients had an initial objective tumor response, and 26 (90%) had a sustained complete response during 24 months of clinical follow-up. The treatment was well tolerated, with four (14%) patients having grade 3 leukopenia and two (7%) having grade 3 thrombocytopenia. The authors concluded that radiation segmentectomy should be investigated further as a potentially curative option for patients with HCC.
Portal vein thrombosis (PVT) has been considered a contraindication to transarterial chemoembolization (TACE) due to the concern for inadvertent liver ischemia if the hepatic artery becomes obstructed. Several studies have demonstrated that this risk is low. Stereotactic body radiation therapy (SBRT) is used to effectively target HCC (especially when there is a portal vein tumor) while minimizing collateral damage to the liver. Zhang and colleagues performed a meta-analysis of nine studies totaling 938 patients who had HCC with tumor PVT. Of those, 483 received either SBRT or TACE, and 455 were treated with both TACE and SBRT. There were 255 events reported in the monotherapy groups and 174 events in the combination groups. Following statistical analyses of all available data, the authors concluded that SBRT plus TACE yielded significantly higher 1-year OS (RR [relative risk] 1.52; 95% CI 1.33-1.74), 2-year OS (RR 2.00; 95% CI 1.48-2.70), and a lower progressive disease rate (RR 0.45; 95% CI 0.26-0.79) than monotherapy. The combination treatment was both safe and effective.
Liver transplantation cures both HCC and the underlying cirrhosis; however, tumor progression while the patient is on the waiting list is an ongoing concern. Couillard and colleagues reported a retrospective study of 88 patients with HCC who underwent percutaneous microwave ablation for 141 tumors while on the liver transplant list. The median follow-up was 61 months. Seventy-one patients (80.7%) underwent liver transplantation after a median wait time of 8.5 months. No tumor seeding was identified. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) of whom because of tumor progression outside of the Milan criteria. A total of five of 71 (7.0%) patients had posttransplant recurrence of HCC and all died during this time. The 5-year overall survival (OS) following liver transplantation was 76.7% and the disease-specific survival after transplantation was 89.6%. The authors concluded that microwave ablation is a safe and effective treatment that bridges patients to successful transplantation.
Radiation segmentectomy is performed by the administration of radioactive yttrium (90Y)-bound microspheres transarterially to the segment of liver containing an unresected tumor. Kim and colleagues described the results of a prospective trial that evaluated the efficacy of radiation segmentectomy with curative intent in patients with Child-Pugh score A–B7 and small (< 3 cm), unresectable HCC, where the tumors were in a location unsuitable for ablation. Of the 44 individuals assessed for eligibility, 29 patients were included in the study. A complete response was observed in 24 (83%) patients, and a partial response was observed in 5 (17%) patients. All patients had an initial objective tumor response, and 26 (90%) had a sustained complete response during 24 months of clinical follow-up. The treatment was well tolerated, with four (14%) patients having grade 3 leukopenia and two (7%) having grade 3 thrombocytopenia. The authors concluded that radiation segmentectomy should be investigated further as a potentially curative option for patients with HCC.
Portal vein thrombosis (PVT) has been considered a contraindication to transarterial chemoembolization (TACE) due to the concern for inadvertent liver ischemia if the hepatic artery becomes obstructed. Several studies have demonstrated that this risk is low. Stereotactic body radiation therapy (SBRT) is used to effectively target HCC (especially when there is a portal vein tumor) while minimizing collateral damage to the liver. Zhang and colleagues performed a meta-analysis of nine studies totaling 938 patients who had HCC with tumor PVT. Of those, 483 received either SBRT or TACE, and 455 were treated with both TACE and SBRT. There were 255 events reported in the monotherapy groups and 174 events in the combination groups. Following statistical analyses of all available data, the authors concluded that SBRT plus TACE yielded significantly higher 1-year OS (RR [relative risk] 1.52; 95% CI 1.33-1.74), 2-year OS (RR 2.00; 95% CI 1.48-2.70), and a lower progressive disease rate (RR 0.45; 95% CI 0.26-0.79) than monotherapy. The combination treatment was both safe and effective.
Liver transplantation cures both HCC and the underlying cirrhosis; however, tumor progression while the patient is on the waiting list is an ongoing concern. Couillard and colleagues reported a retrospective study of 88 patients with HCC who underwent percutaneous microwave ablation for 141 tumors while on the liver transplant list. The median follow-up was 61 months. Seventy-one patients (80.7%) underwent liver transplantation after a median wait time of 8.5 months. No tumor seeding was identified. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) of whom because of tumor progression outside of the Milan criteria. A total of five of 71 (7.0%) patients had posttransplant recurrence of HCC and all died during this time. The 5-year overall survival (OS) following liver transplantation was 76.7% and the disease-specific survival after transplantation was 89.6%. The authors concluded that microwave ablation is a safe and effective treatment that bridges patients to successful transplantation.
Radiation segmentectomy is performed by the administration of radioactive yttrium (90Y)-bound microspheres transarterially to the segment of liver containing an unresected tumor. Kim and colleagues described the results of a prospective trial that evaluated the efficacy of radiation segmentectomy with curative intent in patients with Child-Pugh score A–B7 and small (< 3 cm), unresectable HCC, where the tumors were in a location unsuitable for ablation. Of the 44 individuals assessed for eligibility, 29 patients were included in the study. A complete response was observed in 24 (83%) patients, and a partial response was observed in 5 (17%) patients. All patients had an initial objective tumor response, and 26 (90%) had a sustained complete response during 24 months of clinical follow-up. The treatment was well tolerated, with four (14%) patients having grade 3 leukopenia and two (7%) having grade 3 thrombocytopenia. The authors concluded that radiation segmentectomy should be investigated further as a potentially curative option for patients with HCC.
Portal vein thrombosis (PVT) has been considered a contraindication to transarterial chemoembolization (TACE) due to the concern for inadvertent liver ischemia if the hepatic artery becomes obstructed. Several studies have demonstrated that this risk is low. Stereotactic body radiation therapy (SBRT) is used to effectively target HCC (especially when there is a portal vein tumor) while minimizing collateral damage to the liver. Zhang and colleagues performed a meta-analysis of nine studies totaling 938 patients who had HCC with tumor PVT. Of those, 483 received either SBRT or TACE, and 455 were treated with both TACE and SBRT. There were 255 events reported in the monotherapy groups and 174 events in the combination groups. Following statistical analyses of all available data, the authors concluded that SBRT plus TACE yielded significantly higher 1-year OS (RR [relative risk] 1.52; 95% CI 1.33-1.74), 2-year OS (RR 2.00; 95% CI 1.48-2.70), and a lower progressive disease rate (RR 0.45; 95% CI 0.26-0.79) than monotherapy. The combination treatment was both safe and effective.
Commentary: Locoregional Treatments for HCC, July 2022
Liver transplantation cures both HCC and the underlying cirrhosis; however, tumor progression while the patient is on the waiting list is an ongoing concern. Couillard and colleagues reported a retrospective study of 88 patients with HCC who underwent percutaneous microwave ablation for 141 tumors while on the liver transplant list. The median follow-up was 61 months. Seventy-one patients (80.7%) underwent liver transplantation after a median wait time of 8.5 months. No tumor seeding was identified. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) of whom because of tumor progression outside of the Milan criteria. A total of five of 71 (7.0%) patients had posttransplant recurrence of HCC and all died during this time. The 5-year overall survival (OS) following liver transplantation was 76.7% and the disease-specific survival after transplantation was 89.6%. The authors concluded that microwave ablation is a safe and effective treatment that bridges patients to successful transplantation.
Radiation segmentectomy is performed by the administration of radioactive yttrium (90Y)-bound microspheres transarterially to the segment of liver containing an unresected tumor. Kim and colleagues described the results of a prospective trial that evaluated the efficacy of radiation segmentectomy with curative intent in patients with Child-Pugh score A–B7 and small (< 3 cm), unresectable HCC, where the tumors were in a location unsuitable for ablation. Of the 44 individuals assessed for eligibility, 29 patients were included in the study. A complete response was observed in 24 (83%) patients, and a partial response was observed in 5 (17%) patients. All patients had an initial objective tumor response, and 26 (90%) had a sustained complete response during 24 months of clinical follow-up. The treatment was well tolerated, with four (14%) patients having grade 3 leukopenia and two (7%) having grade 3 thrombocytopenia. The authors concluded that radiation segmentectomy should be investigated further as a potentially curative option for patients with HCC.
Portal vein thrombosis (PVT) has been considered a contraindication to transarterial chemoembolization (TACE) due to the concern for inadvertent liver ischemia if the hepatic artery becomes obstructed. Several studies have demonstrated that this risk is low. Stereotactic body radiation therapy (SBRT) is used to effectively target HCC (especially when there is a portal vein tumor) while minimizing collateral damage to the liver. Zhang and colleagues performed a meta-analysis of nine studies totaling 938 patients who had HCC with tumor PVT. Of those, 483 received either SBRT or TACE, and 455 were treated with both TACE and SBRT. There were 255 events reported in the monotherapy groups and 174 events in the combination groups. Following statistical analyses of all available data, the authors concluded that SBRT plus TACE yielded significantly higher 1-year OS (RR [relative risk] 1.52; 95% CI 1.33-1.74), 2-year OS (RR 2.00; 95% CI 1.48-2.70), and a lower progressive disease rate (RR 0.45; 95% CI 0.26-0.79) than monotherapy. The combination treatment was both safe and effective.
Liver transplantation cures both HCC and the underlying cirrhosis; however, tumor progression while the patient is on the waiting list is an ongoing concern. Couillard and colleagues reported a retrospective study of 88 patients with HCC who underwent percutaneous microwave ablation for 141 tumors while on the liver transplant list. The median follow-up was 61 months. Seventy-one patients (80.7%) underwent liver transplantation after a median wait time of 8.5 months. No tumor seeding was identified. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) of whom because of tumor progression outside of the Milan criteria. A total of five of 71 (7.0%) patients had posttransplant recurrence of HCC and all died during this time. The 5-year overall survival (OS) following liver transplantation was 76.7% and the disease-specific survival after transplantation was 89.6%. The authors concluded that microwave ablation is a safe and effective treatment that bridges patients to successful transplantation.
Radiation segmentectomy is performed by the administration of radioactive yttrium (90Y)-bound microspheres transarterially to the segment of liver containing an unresected tumor. Kim and colleagues described the results of a prospective trial that evaluated the efficacy of radiation segmentectomy with curative intent in patients with Child-Pugh score A–B7 and small (< 3 cm), unresectable HCC, where the tumors were in a location unsuitable for ablation. Of the 44 individuals assessed for eligibility, 29 patients were included in the study. A complete response was observed in 24 (83%) patients, and a partial response was observed in 5 (17%) patients. All patients had an initial objective tumor response, and 26 (90%) had a sustained complete response during 24 months of clinical follow-up. The treatment was well tolerated, with four (14%) patients having grade 3 leukopenia and two (7%) having grade 3 thrombocytopenia. The authors concluded that radiation segmentectomy should be investigated further as a potentially curative option for patients with HCC.
Portal vein thrombosis (PVT) has been considered a contraindication to transarterial chemoembolization (TACE) due to the concern for inadvertent liver ischemia if the hepatic artery becomes obstructed. Several studies have demonstrated that this risk is low. Stereotactic body radiation therapy (SBRT) is used to effectively target HCC (especially when there is a portal vein tumor) while minimizing collateral damage to the liver. Zhang and colleagues performed a meta-analysis of nine studies totaling 938 patients who had HCC with tumor PVT. Of those, 483 received either SBRT or TACE, and 455 were treated with both TACE and SBRT. There were 255 events reported in the monotherapy groups and 174 events in the combination groups. Following statistical analyses of all available data, the authors concluded that SBRT plus TACE yielded significantly higher 1-year OS (RR [relative risk] 1.52; 95% CI 1.33-1.74), 2-year OS (RR 2.00; 95% CI 1.48-2.70), and a lower progressive disease rate (RR 0.45; 95% CI 0.26-0.79) than monotherapy. The combination treatment was both safe and effective.
Liver transplantation cures both HCC and the underlying cirrhosis; however, tumor progression while the patient is on the waiting list is an ongoing concern. Couillard and colleagues reported a retrospective study of 88 patients with HCC who underwent percutaneous microwave ablation for 141 tumors while on the liver transplant list. The median follow-up was 61 months. Seventy-one patients (80.7%) underwent liver transplantation after a median wait time of 8.5 months. No tumor seeding was identified. Seventeen patients (19.3%) were removed from the waitlist, four (4.5%) of whom because of tumor progression outside of the Milan criteria. A total of five of 71 (7.0%) patients had posttransplant recurrence of HCC and all died during this time. The 5-year overall survival (OS) following liver transplantation was 76.7% and the disease-specific survival after transplantation was 89.6%. The authors concluded that microwave ablation is a safe and effective treatment that bridges patients to successful transplantation.
Radiation segmentectomy is performed by the administration of radioactive yttrium (90Y)-bound microspheres transarterially to the segment of liver containing an unresected tumor. Kim and colleagues described the results of a prospective trial that evaluated the efficacy of radiation segmentectomy with curative intent in patients with Child-Pugh score A–B7 and small (< 3 cm), unresectable HCC, where the tumors were in a location unsuitable for ablation. Of the 44 individuals assessed for eligibility, 29 patients were included in the study. A complete response was observed in 24 (83%) patients, and a partial response was observed in 5 (17%) patients. All patients had an initial objective tumor response, and 26 (90%) had a sustained complete response during 24 months of clinical follow-up. The treatment was well tolerated, with four (14%) patients having grade 3 leukopenia and two (7%) having grade 3 thrombocytopenia. The authors concluded that radiation segmentectomy should be investigated further as a potentially curative option for patients with HCC.
Portal vein thrombosis (PVT) has been considered a contraindication to transarterial chemoembolization (TACE) due to the concern for inadvertent liver ischemia if the hepatic artery becomes obstructed. Several studies have demonstrated that this risk is low. Stereotactic body radiation therapy (SBRT) is used to effectively target HCC (especially when there is a portal vein tumor) while minimizing collateral damage to the liver. Zhang and colleagues performed a meta-analysis of nine studies totaling 938 patients who had HCC with tumor PVT. Of those, 483 received either SBRT or TACE, and 455 were treated with both TACE and SBRT. There were 255 events reported in the monotherapy groups and 174 events in the combination groups. Following statistical analyses of all available data, the authors concluded that SBRT plus TACE yielded significantly higher 1-year OS (RR [relative risk] 1.52; 95% CI 1.33-1.74), 2-year OS (RR 2.00; 95% CI 1.48-2.70), and a lower progressive disease rate (RR 0.45; 95% CI 0.26-0.79) than monotherapy. The combination treatment was both safe and effective.
SBRT plus TACE better than monotherapy in HCC with portal vein tumor thrombus
Key clinical point: Stereotactic body radiotherapy (SBRT) plus transcatheter arterial chemoembolization (TACE) may be safe and more effective than either of the procedures alone (monotherapy) for treating inoperable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).
Major finding: SBRT plus TACE vs. monotherapy led to significantly higher overall survival (1-year: risk ratio [RR] 1.52; 95% CI 1.33-1.74; 2-year: RR 2.00; 95% CI 1.48-2.70) and objective response (RR 1.22; 95% CI 1.08-1.37) rates, a significantly lower disease progression rate (RR 0.45; 95% CI 0.26-0.79), and a similar adverse event incidence (RR 1.03; 95% CI 0.82-1.31).
Study details: This was a meta-analysis of nine studies involving 938 patients with inoperable HCC and PVTT who received SBRT plus TACE (n = 455) or monotherapy (n = 483).
Disclosures: The study was sponsored by Chinese Medical Hand in Hand Project Committee & Beijing Medical Award Foundation, among others. The authors declared no conflicts of interest.
Source: Zhang X-F et al. Stereotactic body radiotherapy plus transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma patients with portal vein tumour thrombus: A meta-analysis. PLoS One. 2022;17(5): e0268779 (May 20). Doi: 10.1371/journal.pone.0268779
Key clinical point: Stereotactic body radiotherapy (SBRT) plus transcatheter arterial chemoembolization (TACE) may be safe and more effective than either of the procedures alone (monotherapy) for treating inoperable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).
Major finding: SBRT plus TACE vs. monotherapy led to significantly higher overall survival (1-year: risk ratio [RR] 1.52; 95% CI 1.33-1.74; 2-year: RR 2.00; 95% CI 1.48-2.70) and objective response (RR 1.22; 95% CI 1.08-1.37) rates, a significantly lower disease progression rate (RR 0.45; 95% CI 0.26-0.79), and a similar adverse event incidence (RR 1.03; 95% CI 0.82-1.31).
Study details: This was a meta-analysis of nine studies involving 938 patients with inoperable HCC and PVTT who received SBRT plus TACE (n = 455) or monotherapy (n = 483).
Disclosures: The study was sponsored by Chinese Medical Hand in Hand Project Committee & Beijing Medical Award Foundation, among others. The authors declared no conflicts of interest.
Source: Zhang X-F et al. Stereotactic body radiotherapy plus transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma patients with portal vein tumour thrombus: A meta-analysis. PLoS One. 2022;17(5): e0268779 (May 20). Doi: 10.1371/journal.pone.0268779
Key clinical point: Stereotactic body radiotherapy (SBRT) plus transcatheter arterial chemoembolization (TACE) may be safe and more effective than either of the procedures alone (monotherapy) for treating inoperable hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).
Major finding: SBRT plus TACE vs. monotherapy led to significantly higher overall survival (1-year: risk ratio [RR] 1.52; 95% CI 1.33-1.74; 2-year: RR 2.00; 95% CI 1.48-2.70) and objective response (RR 1.22; 95% CI 1.08-1.37) rates, a significantly lower disease progression rate (RR 0.45; 95% CI 0.26-0.79), and a similar adverse event incidence (RR 1.03; 95% CI 0.82-1.31).
Study details: This was a meta-analysis of nine studies involving 938 patients with inoperable HCC and PVTT who received SBRT plus TACE (n = 455) or monotherapy (n = 483).
Disclosures: The study was sponsored by Chinese Medical Hand in Hand Project Committee & Beijing Medical Award Foundation, among others. The authors declared no conflicts of interest.
Source: Zhang X-F et al. Stereotactic body radiotherapy plus transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma patients with portal vein tumour thrombus: A meta-analysis. PLoS One. 2022;17(5): e0268779 (May 20). Doi: 10.1371/journal.pone.0268779
Unresectable HCC: Differential efficacy of atezolizumab plus bevacizumab according to hepatic function grade
Key clinical point: Atezolizumab plus bevacizumab (Atez/Bev) shows potent therapeutic efficacy against unresectable hepatocellular carcinoma (uHCC) in patients with a good hepatic function, classified as Child-Pugh A (CP-A), but has decreased efficacy in those with CP-B.
Major finding: Patients with CP-A vs. CP-B showed better 6-, 12-, and 18-month progression-free (58.2%, 36.1%, and 27.8% vs. 49.6%, 8.7%, and non-estimable, respectively; P < .001) and overall (89.9%, 71.7%, and 51.4% vs. 63.6%, 18.4%, and non-estimable, respectively; P < .001) survival rates.
Study details: This retrospective study included 457 patients with uHCC and CP-A (n = 427) or CP-B (n = 30) who received Atez/Bev.
Disclosures: This study received no financial support. Some authors declared serving as advisors for and receiving lecture fees or research funds from various sources. Two authors declared serving as editors/editorial board members of Liver Cancer.
Source: Tanaka T et al. Therapeutic efficacy of atezolizumab plus bevacizumab treatment for unresectable hepatocellular carcinoma in patients with Child-Pugh class A or B liver function in real-world clinical practice. Hepatol Res. 2022 (May 28). Doi: 10.1111/hepr.13797
Key clinical point: Atezolizumab plus bevacizumab (Atez/Bev) shows potent therapeutic efficacy against unresectable hepatocellular carcinoma (uHCC) in patients with a good hepatic function, classified as Child-Pugh A (CP-A), but has decreased efficacy in those with CP-B.
Major finding: Patients with CP-A vs. CP-B showed better 6-, 12-, and 18-month progression-free (58.2%, 36.1%, and 27.8% vs. 49.6%, 8.7%, and non-estimable, respectively; P < .001) and overall (89.9%, 71.7%, and 51.4% vs. 63.6%, 18.4%, and non-estimable, respectively; P < .001) survival rates.
Study details: This retrospective study included 457 patients with uHCC and CP-A (n = 427) or CP-B (n = 30) who received Atez/Bev.
Disclosures: This study received no financial support. Some authors declared serving as advisors for and receiving lecture fees or research funds from various sources. Two authors declared serving as editors/editorial board members of Liver Cancer.
Source: Tanaka T et al. Therapeutic efficacy of atezolizumab plus bevacizumab treatment for unresectable hepatocellular carcinoma in patients with Child-Pugh class A or B liver function in real-world clinical practice. Hepatol Res. 2022 (May 28). Doi: 10.1111/hepr.13797
Key clinical point: Atezolizumab plus bevacizumab (Atez/Bev) shows potent therapeutic efficacy against unresectable hepatocellular carcinoma (uHCC) in patients with a good hepatic function, classified as Child-Pugh A (CP-A), but has decreased efficacy in those with CP-B.
Major finding: Patients with CP-A vs. CP-B showed better 6-, 12-, and 18-month progression-free (58.2%, 36.1%, and 27.8% vs. 49.6%, 8.7%, and non-estimable, respectively; P < .001) and overall (89.9%, 71.7%, and 51.4% vs. 63.6%, 18.4%, and non-estimable, respectively; P < .001) survival rates.
Study details: This retrospective study included 457 patients with uHCC and CP-A (n = 427) or CP-B (n = 30) who received Atez/Bev.
Disclosures: This study received no financial support. Some authors declared serving as advisors for and receiving lecture fees or research funds from various sources. Two authors declared serving as editors/editorial board members of Liver Cancer.
Source: Tanaka T et al. Therapeutic efficacy of atezolizumab plus bevacizumab treatment for unresectable hepatocellular carcinoma in patients with Child-Pugh class A or B liver function in real-world clinical practice. Hepatol Res. 2022 (May 28). Doi: 10.1111/hepr.13797
Atezolizumab plus bevacizumab offers a better prognosis than lenvatinib in unresectable HCC
Key clinical point: Therapy with atezolizumab plus bevacizumab (Atez/Bev) vs. lenvatinib in the first-line setting may confer a survival benefit in patients with unresectable hepatocellular carcinoma (uHCC).
Major finding: Patients receiving Atez/Bev vs. lenvatinib showed better overall survival (1 year: 67.2% vs. 66.2%; 1.5 years: 58.1% vs. 52.7%; P = .002) and progression-free survival (1 year: 31.6% vs. 20.4%; 1.5 years: non-estimable vs. 11.2%; P < .0001) rates.
Study details: This retrospective study included 251 systemic treatment-naive patients with uHCC who received standard-dose Atez/Bev (n = 194) or lenvatinib (n = 57).
Disclosures: The study did not receive any funding. Some authors declared serving as advisors or receiving lecture fees or research funding from various sources.
Source: Hiraoka A et al. Does first-line treatment have prognostic impact for unresectable HCC?—Atezolizumab plus bevacizumab versus lenvatinib .Cancer Med. 2022 (Jun 3). Doi: 10.1002/cam4.4854
Key clinical point: Therapy with atezolizumab plus bevacizumab (Atez/Bev) vs. lenvatinib in the first-line setting may confer a survival benefit in patients with unresectable hepatocellular carcinoma (uHCC).
Major finding: Patients receiving Atez/Bev vs. lenvatinib showed better overall survival (1 year: 67.2% vs. 66.2%; 1.5 years: 58.1% vs. 52.7%; P = .002) and progression-free survival (1 year: 31.6% vs. 20.4%; 1.5 years: non-estimable vs. 11.2%; P < .0001) rates.
Study details: This retrospective study included 251 systemic treatment-naive patients with uHCC who received standard-dose Atez/Bev (n = 194) or lenvatinib (n = 57).
Disclosures: The study did not receive any funding. Some authors declared serving as advisors or receiving lecture fees or research funding from various sources.
Source: Hiraoka A et al. Does first-line treatment have prognostic impact for unresectable HCC?—Atezolizumab plus bevacizumab versus lenvatinib .Cancer Med. 2022 (Jun 3). Doi: 10.1002/cam4.4854
Key clinical point: Therapy with atezolizumab plus bevacizumab (Atez/Bev) vs. lenvatinib in the first-line setting may confer a survival benefit in patients with unresectable hepatocellular carcinoma (uHCC).
Major finding: Patients receiving Atez/Bev vs. lenvatinib showed better overall survival (1 year: 67.2% vs. 66.2%; 1.5 years: 58.1% vs. 52.7%; P = .002) and progression-free survival (1 year: 31.6% vs. 20.4%; 1.5 years: non-estimable vs. 11.2%; P < .0001) rates.
Study details: This retrospective study included 251 systemic treatment-naive patients with uHCC who received standard-dose Atez/Bev (n = 194) or lenvatinib (n = 57).
Disclosures: The study did not receive any funding. Some authors declared serving as advisors or receiving lecture fees or research funding from various sources.
Source: Hiraoka A et al. Does first-line treatment have prognostic impact for unresectable HCC?—Atezolizumab plus bevacizumab versus lenvatinib .Cancer Med. 2022 (Jun 3). Doi: 10.1002/cam4.4854
HCC with Child-Pugh B cirrhosis: Nivolumab a promising first-line systemic treatment option
Key clinical point: Nivolumab may serve as a first-line systemic treatment option in patients with hepatocellular carcinoma (HCC) and Child-Pugh B (CP-B) cirrhosis.
Major finding: Patients receiving nivolumab vs. sorafenib had a 31% reduced hazard of death (adjusted hazard ratio 0.69; P = .008) and were less likely to discontinue treatment due to toxicity (12% vs. 36%; P = .001).
Study details: The data come from a retrospective real-world cohort study that included patients with HCC and CP-B cirrhosis who received nivolumab (n = 79) or sorafenib (n = 431) as the first-line systemic treatment.
Disclosures: The study was funded by the US National Institutes of Health. Some authors declared serving on the advisory boards of or receiving honoraria or research grants from various sources.
Source: Chapin WJ et al. Comparison of nivolumab and sorafenib for first systemic therapy in patients with hepatocellular carcinoma and Child-Pugh B cirrhosis. Cancer Med. 2022 (Jun 2). Doi: 10.1002/cam4.4906
Key clinical point: Nivolumab may serve as a first-line systemic treatment option in patients with hepatocellular carcinoma (HCC) and Child-Pugh B (CP-B) cirrhosis.
Major finding: Patients receiving nivolumab vs. sorafenib had a 31% reduced hazard of death (adjusted hazard ratio 0.69; P = .008) and were less likely to discontinue treatment due to toxicity (12% vs. 36%; P = .001).
Study details: The data come from a retrospective real-world cohort study that included patients with HCC and CP-B cirrhosis who received nivolumab (n = 79) or sorafenib (n = 431) as the first-line systemic treatment.
Disclosures: The study was funded by the US National Institutes of Health. Some authors declared serving on the advisory boards of or receiving honoraria or research grants from various sources.
Source: Chapin WJ et al. Comparison of nivolumab and sorafenib for first systemic therapy in patients with hepatocellular carcinoma and Child-Pugh B cirrhosis. Cancer Med. 2022 (Jun 2). Doi: 10.1002/cam4.4906
Key clinical point: Nivolumab may serve as a first-line systemic treatment option in patients with hepatocellular carcinoma (HCC) and Child-Pugh B (CP-B) cirrhosis.
Major finding: Patients receiving nivolumab vs. sorafenib had a 31% reduced hazard of death (adjusted hazard ratio 0.69; P = .008) and were less likely to discontinue treatment due to toxicity (12% vs. 36%; P = .001).
Study details: The data come from a retrospective real-world cohort study that included patients with HCC and CP-B cirrhosis who received nivolumab (n = 79) or sorafenib (n = 431) as the first-line systemic treatment.
Disclosures: The study was funded by the US National Institutes of Health. Some authors declared serving on the advisory boards of or receiving honoraria or research grants from various sources.
Source: Chapin WJ et al. Comparison of nivolumab and sorafenib for first systemic therapy in patients with hepatocellular carcinoma and Child-Pugh B cirrhosis. Cancer Med. 2022 (Jun 2). Doi: 10.1002/cam4.4906
Preoperative ratio of creatinine and cystatin C estimated glomerular filtration rates predicts survival outcomes after hepatic resection for HCC
Key clinical point: The preoperative ratio of creatinine and cystatin C estimated glomerular filtration rates (eGFRcre/eGFRcys) can predict overall survival (OS) and recurrence-free survival (RFS) in patients with hepatocellular carcinoma (HCC) undergoing hepatic resection.
Major finding: High eGFRcre/eGFRcys (>1.0025) was significantly associated with worse OS (adjusted hazard ratio [aHR] 4.07; P = .03) and RFS (aHR 2.12; P = .04).
Study details: The data come from a retrospective study that included 157 patients with HCC who underwent curative hepatic resection.
Disclosures: The study was sponsored by Grants-in-Aid for Scientific Research, Japan Society for the Promotion of Science. The authors reported no conflicts of interest.
Source: Harimoto N et al. The ratio of creatinine and cystatin C estimated glomerular filtration rates as a surrogate marker in patients with hepatocellular carcinoma undergoing hepatic resection. J Hepatobiliary Pancreat Sci. 2022 (May 11). Doi: 10.1002/jhbp.1164
Key clinical point: The preoperative ratio of creatinine and cystatin C estimated glomerular filtration rates (eGFRcre/eGFRcys) can predict overall survival (OS) and recurrence-free survival (RFS) in patients with hepatocellular carcinoma (HCC) undergoing hepatic resection.
Major finding: High eGFRcre/eGFRcys (>1.0025) was significantly associated with worse OS (adjusted hazard ratio [aHR] 4.07; P = .03) and RFS (aHR 2.12; P = .04).
Study details: The data come from a retrospective study that included 157 patients with HCC who underwent curative hepatic resection.
Disclosures: The study was sponsored by Grants-in-Aid for Scientific Research, Japan Society for the Promotion of Science. The authors reported no conflicts of interest.
Source: Harimoto N et al. The ratio of creatinine and cystatin C estimated glomerular filtration rates as a surrogate marker in patients with hepatocellular carcinoma undergoing hepatic resection. J Hepatobiliary Pancreat Sci. 2022 (May 11). Doi: 10.1002/jhbp.1164
Key clinical point: The preoperative ratio of creatinine and cystatin C estimated glomerular filtration rates (eGFRcre/eGFRcys) can predict overall survival (OS) and recurrence-free survival (RFS) in patients with hepatocellular carcinoma (HCC) undergoing hepatic resection.
Major finding: High eGFRcre/eGFRcys (>1.0025) was significantly associated with worse OS (adjusted hazard ratio [aHR] 4.07; P = .03) and RFS (aHR 2.12; P = .04).
Study details: The data come from a retrospective study that included 157 patients with HCC who underwent curative hepatic resection.
Disclosures: The study was sponsored by Grants-in-Aid for Scientific Research, Japan Society for the Promotion of Science. The authors reported no conflicts of interest.
Source: Harimoto N et al. The ratio of creatinine and cystatin C estimated glomerular filtration rates as a surrogate marker in patients with hepatocellular carcinoma undergoing hepatic resection. J Hepatobiliary Pancreat Sci. 2022 (May 11). Doi: 10.1002/jhbp.1164
C reactive protein to albumin ratio predicts survival outcomes in lenvatinib-treated patients with unresectable HCC
Key clinical point: C-reactive protein to albumin ratio (CAR) can predict overall survival (OS) and progression-free survival (PFS) in patients treated with lenvatinib for unresectable hepatocellular carcinoma (uHCC).
Major finding: High CAR (≥0.108) was independently associated with OS (adjusted hazard ratio [aHR] 1.915; P < .001) and PFS (aHR 1.644; P < .001). Patients with low vs. high CAR showed significantly better cumulative OS and PFS (both P < .001).
Study details: This retrospective, multicenter study included 522 patients with uHCC who were treated with lenvatinib for >2 weeks, followed-up for >4 weeks, and had CAR data available at the beginning of follow-up.
Disclosures: This study did not receive any funding. Some authors reported serving as advisors for or receiving research funds or lecture fees from various sources.
Source: Tada T et al. C-reactive protein to albumin ratio predicts survival in patients with unresectable hepatocellular carcinoma treated with Lenvatinib. Sci Rep. 2022;12:8421 (May 19). Doi: 10.1038/s41598-022-12058-y
Key clinical point: C-reactive protein to albumin ratio (CAR) can predict overall survival (OS) and progression-free survival (PFS) in patients treated with lenvatinib for unresectable hepatocellular carcinoma (uHCC).
Major finding: High CAR (≥0.108) was independently associated with OS (adjusted hazard ratio [aHR] 1.915; P < .001) and PFS (aHR 1.644; P < .001). Patients with low vs. high CAR showed significantly better cumulative OS and PFS (both P < .001).
Study details: This retrospective, multicenter study included 522 patients with uHCC who were treated with lenvatinib for >2 weeks, followed-up for >4 weeks, and had CAR data available at the beginning of follow-up.
Disclosures: This study did not receive any funding. Some authors reported serving as advisors for or receiving research funds or lecture fees from various sources.
Source: Tada T et al. C-reactive protein to albumin ratio predicts survival in patients with unresectable hepatocellular carcinoma treated with Lenvatinib. Sci Rep. 2022;12:8421 (May 19). Doi: 10.1038/s41598-022-12058-y
Key clinical point: C-reactive protein to albumin ratio (CAR) can predict overall survival (OS) and progression-free survival (PFS) in patients treated with lenvatinib for unresectable hepatocellular carcinoma (uHCC).
Major finding: High CAR (≥0.108) was independently associated with OS (adjusted hazard ratio [aHR] 1.915; P < .001) and PFS (aHR 1.644; P < .001). Patients with low vs. high CAR showed significantly better cumulative OS and PFS (both P < .001).
Study details: This retrospective, multicenter study included 522 patients with uHCC who were treated with lenvatinib for >2 weeks, followed-up for >4 weeks, and had CAR data available at the beginning of follow-up.
Disclosures: This study did not receive any funding. Some authors reported serving as advisors for or receiving research funds or lecture fees from various sources.
Source: Tada T et al. C-reactive protein to albumin ratio predicts survival in patients with unresectable hepatocellular carcinoma treated with Lenvatinib. Sci Rep. 2022;12:8421 (May 19). Doi: 10.1038/s41598-022-12058-y
NAFLD significantly increases the risk for HCC
Key clinical point: Nonalcoholic fatty liver disease (NAFLD) is independently associated with an increased risk for hepatocellular carcinoma (HCC).
Major finding: NAFLD significantly increased the risk for HCC (hazard ratio [HR] 1.88; P < .01) but not for recurrence (HR 0.97; P = .73), cancer mortality (HR 2.16; P = .1), or all-cause mortality (HR 1.02; P = .84).
Study details: Findings are from a meta-analysis of 103 observational studies that evaluated HCC risk and outcomes in 948,217 patients with NAFLD.
Disclosures: This study received no funding. The authors declared no conflicts of interest.
Source: Petrelli F et al. Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: HCC and steatosis or steatohepatitis. Neoplasia. 2022;30:100809 (May 27). Doi: 10.1016/j.neo.2022.100809
Key clinical point: Nonalcoholic fatty liver disease (NAFLD) is independently associated with an increased risk for hepatocellular carcinoma (HCC).
Major finding: NAFLD significantly increased the risk for HCC (hazard ratio [HR] 1.88; P < .01) but not for recurrence (HR 0.97; P = .73), cancer mortality (HR 2.16; P = .1), or all-cause mortality (HR 1.02; P = .84).
Study details: Findings are from a meta-analysis of 103 observational studies that evaluated HCC risk and outcomes in 948,217 patients with NAFLD.
Disclosures: This study received no funding. The authors declared no conflicts of interest.
Source: Petrelli F et al. Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: HCC and steatosis or steatohepatitis. Neoplasia. 2022;30:100809 (May 27). Doi: 10.1016/j.neo.2022.100809
Key clinical point: Nonalcoholic fatty liver disease (NAFLD) is independently associated with an increased risk for hepatocellular carcinoma (HCC).
Major finding: NAFLD significantly increased the risk for HCC (hazard ratio [HR] 1.88; P < .01) but not for recurrence (HR 0.97; P = .73), cancer mortality (HR 2.16; P = .1), or all-cause mortality (HR 1.02; P = .84).
Study details: Findings are from a meta-analysis of 103 observational studies that evaluated HCC risk and outcomes in 948,217 patients with NAFLD.
Disclosures: This study received no funding. The authors declared no conflicts of interest.
Source: Petrelli F et al. Hepatocellular carcinoma in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis: HCC and steatosis or steatohepatitis. Neoplasia. 2022;30:100809 (May 27). Doi: 10.1016/j.neo.2022.100809
Microwave ablation bridges patients with HCC to liver transplant
Key clinical point: Microwave ablation may be a safe and effective first-line locoregional therapy (LRT) for bridging patients with hepatocellular carcinoma (HCC) to liver transplant (LT), with no cases of waitlist removal due to tumor seeding, procedural adverse events, or local tumor progression.
Major finding: In total, 71 (80.7%) of 88 patients eventually received LT. None of the patients died while on the waitlist, and only 4.5% of patients dropped out due to tumor growth outside of the Milan Criteria. The 5-year post-transplant overall survival rate was 76.7%, with the overall and major adverse event rates being 5.1% and 3.0%, respectively.
Study details: Findings are from a single-center, retrospective study including 88 patients with HCC on the waitlist for LT who received percutaneous microwave ablation as the first-line LRT.
Disclosures: The study did not receive any funding. Some authors declared consulting for, being on the board of directors or a shareholder of, or receiving research support from various sources.
Source: Couillard AB et al. Microwave ablation as bridging to liver transplant for patients with hepatocellular carcinoma: A single-center retrospective analysis. J Vasc Interv Radiol. 2022 (Jun 3). Doi: 10.1016/j.jvir.2022.05.019
Key clinical point: Microwave ablation may be a safe and effective first-line locoregional therapy (LRT) for bridging patients with hepatocellular carcinoma (HCC) to liver transplant (LT), with no cases of waitlist removal due to tumor seeding, procedural adverse events, or local tumor progression.
Major finding: In total, 71 (80.7%) of 88 patients eventually received LT. None of the patients died while on the waitlist, and only 4.5% of patients dropped out due to tumor growth outside of the Milan Criteria. The 5-year post-transplant overall survival rate was 76.7%, with the overall and major adverse event rates being 5.1% and 3.0%, respectively.
Study details: Findings are from a single-center, retrospective study including 88 patients with HCC on the waitlist for LT who received percutaneous microwave ablation as the first-line LRT.
Disclosures: The study did not receive any funding. Some authors declared consulting for, being on the board of directors or a shareholder of, or receiving research support from various sources.
Source: Couillard AB et al. Microwave ablation as bridging to liver transplant for patients with hepatocellular carcinoma: A single-center retrospective analysis. J Vasc Interv Radiol. 2022 (Jun 3). Doi: 10.1016/j.jvir.2022.05.019
Key clinical point: Microwave ablation may be a safe and effective first-line locoregional therapy (LRT) for bridging patients with hepatocellular carcinoma (HCC) to liver transplant (LT), with no cases of waitlist removal due to tumor seeding, procedural adverse events, or local tumor progression.
Major finding: In total, 71 (80.7%) of 88 patients eventually received LT. None of the patients died while on the waitlist, and only 4.5% of patients dropped out due to tumor growth outside of the Milan Criteria. The 5-year post-transplant overall survival rate was 76.7%, with the overall and major adverse event rates being 5.1% and 3.0%, respectively.
Study details: Findings are from a single-center, retrospective study including 88 patients with HCC on the waitlist for LT who received percutaneous microwave ablation as the first-line LRT.
Disclosures: The study did not receive any funding. Some authors declared consulting for, being on the board of directors or a shareholder of, or receiving research support from various sources.
Source: Couillard AB et al. Microwave ablation as bridging to liver transplant for patients with hepatocellular carcinoma: A single-center retrospective analysis. J Vasc Interv Radiol. 2022 (Jun 3). Doi: 10.1016/j.jvir.2022.05.019