Hepatocellular Carcinoma

Key clinical point: Hepatectomy offers greater survival benefits than sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC) and macroscopic portal vein tumor thrombus (PVTT).

Major finding: Patients who underwent hepatectomy vs received sorafenib had a significantly longer median survival time (15.1 vs 4.5 months; hazard ratio 1.704; P  =  .0446).

Study details: This study propensity score-matched patients with advanced HCC and macroscopic PVTT invaded into an ipsilateral first-order portal branch or main trunk/contralateral portal vein who underwent hepatectomy (n = 36) with those who received sorafenib (n = 36).

Disclosures: No source of funding was reported. Some authors reported receiving grants or personal fees from various sources.

Source: Komatsu S et al. Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi-institutional propensity-matched cohort study. J Hepatobiliary Pancreat Sci. 2022 (Sep 1). Doi: 10.1002/jhbp.1236

Key clinical point: Hepatectomy offers greater survival benefits than sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC) and macroscopic portal vein tumor thrombus (PVTT).

Major finding: Patients who underwent hepatectomy vs received sorafenib had a significantly longer median survival time (15.1 vs 4.5 months; hazard ratio 1.704; P  =  .0446).

Study details: This study propensity score-matched patients with advanced HCC and macroscopic PVTT invaded into an ipsilateral first-order portal branch or main trunk/contralateral portal vein who underwent hepatectomy (n = 36) with those who received sorafenib (n = 36).

Disclosures: No source of funding was reported. Some authors reported receiving grants or personal fees from various sources.

Source: Komatsu S et al. Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi-institutional propensity-matched cohort study. J Hepatobiliary Pancreat Sci. 2022 (Sep 1). Doi: 10.1002/jhbp.1236

Key clinical point: Hepatectomy offers greater survival benefits than sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC) and macroscopic portal vein tumor thrombus (PVTT).

Major finding: Patients who underwent hepatectomy vs received sorafenib had a significantly longer median survival time (15.1 vs 4.5 months; hazard ratio 1.704; P  =  .0446).

Study details: This study propensity score-matched patients with advanced HCC and macroscopic PVTT invaded into an ipsilateral first-order portal branch or main trunk/contralateral portal vein who underwent hepatectomy (n = 36) with those who received sorafenib (n = 36).

Disclosures: No source of funding was reported. Some authors reported receiving grants or personal fees from various sources.

Source: Komatsu S et al. Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi-institutional propensity-matched cohort study. J Hepatobiliary Pancreat Sci. 2022 (Sep 1). Doi: 10.1002/jhbp.1236

Key clinical point: Transarterial chemoembolization (TACE) via transradial access (TRA) leads to improved patient satisfaction along with similar procedural variables and safety compared with TACE via transfemoral access (TFA) in patients with hepatocellular carcinoma (HCC).

Major finding: In the TACE-TRA vs TACE-TFA group a significantly higher proportion of patients preferred the current access for their next procedure (90.8% vs 24.6%; P < .001), although between-group procedural variables (such as procedure time and length of hospital stay; all P > .05) and the incidence and severity of adverse events (all P > .05) were similar.

Study details: This single-center prospective randomized controlled trial included 130 patients with HCC who underwent TACE for the first time either via TRA (n = 65) or TFA (n = 65).

Disclosures: This study was sponsored by the Beijing Hope Run Special Fund of the Cancer Foundation of China. The authors declared no conflicts of interest.

Source: Zhang X et al. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized trial. Eur Radiol. 2022 (Aug 26). Doi: 10.1007/s00330-022-09038-1

Key clinical point: Transarterial chemoembolization (TACE) via transradial access (TRA) leads to improved patient satisfaction along with similar procedural variables and safety compared with TACE via transfemoral access (TFA) in patients with hepatocellular carcinoma (HCC).

Major finding: In the TACE-TRA vs TACE-TFA group a significantly higher proportion of patients preferred the current access for their next procedure (90.8% vs 24.6%; P < .001), although between-group procedural variables (such as procedure time and length of hospital stay; all P > .05) and the incidence and severity of adverse events (all P > .05) were similar.

Study details: This single-center prospective randomized controlled trial included 130 patients with HCC who underwent TACE for the first time either via TRA (n = 65) or TFA (n = 65).

Disclosures: This study was sponsored by the Beijing Hope Run Special Fund of the Cancer Foundation of China. The authors declared no conflicts of interest.

Source: Zhang X et al. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized trial. Eur Radiol. 2022 (Aug 26). Doi: 10.1007/s00330-022-09038-1

Key clinical point: Transarterial chemoembolization (TACE) via transradial access (TRA) leads to improved patient satisfaction along with similar procedural variables and safety compared with TACE via transfemoral access (TFA) in patients with hepatocellular carcinoma (HCC).

Major finding: In the TACE-TRA vs TACE-TFA group a significantly higher proportion of patients preferred the current access for their next procedure (90.8% vs 24.6%; P < .001), although between-group procedural variables (such as procedure time and length of hospital stay; all P > .05) and the incidence and severity of adverse events (all P > .05) were similar.

Study details: This single-center prospective randomized controlled trial included 130 patients with HCC who underwent TACE for the first time either via TRA (n = 65) or TFA (n = 65).

Disclosures: This study was sponsored by the Beijing Hope Run Special Fund of the Cancer Foundation of China. The authors declared no conflicts of interest.

Source: Zhang X et al. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized trial. Eur Radiol. 2022 (Aug 26). Doi: 10.1007/s00330-022-09038-1

Key clinical point: Lenvatinib may continue to benefit patients with unresectable hepatocellular carcinoma (uHCC) despite liver function deterioration to Child-Pugh class B (CP-B) after therapy initiation.

Major finding: CP-B vs CP-A patients receiving lenvatinib had a median progression-free survival (PFS) and overall survival (OS) of 3.7 months (95% CI 1.8-7.4) vs 6.5 months (95% CI 5.6-7.4) and 6.8 months (95% CI 2.6-10.3) vs 13.3 months (95% CI 11.6-16.1), respectively. CP-B patients receiving sorafenib had a median PFS and OS of only 0.5 months (95% CI 0.1-3.6) and 4.5 months (95% CI 2.9-6.1, respectively. Lenvatinib showed no new safety signals in CP-B patients.

Study details: This post hoc analysis included patients with uHCC from the REFLECT trial whose liver function deteriorated to CP-B or remained CP-A within 8 weeks of randomization to lenvatinib (CP-B: n = 60; CP-A: n = 413) or sorafenib (CP-B: n = 47; CP-A: n = 427).

Disclosures: This study was funded by Eisai Inc. and Merck Sharp & Dohme (MSD) LLC. Some authors declared serving as speakers, consultants, or advisors for various organizations, including Eisai and MSD.

Source: Huynh J et al. Lenvatinib in patients with unresectable hepatocellular carcinoma who progressed to Child-Pugh B liver function. Ther Adv Med Oncol. 2022;14:17588359221116608 (Aug 24). Doi: 10.1177/17588359221116608

Key clinical point: Lenvatinib may continue to benefit patients with unresectable hepatocellular carcinoma (uHCC) despite liver function deterioration to Child-Pugh class B (CP-B) after therapy initiation.

Major finding: CP-B vs CP-A patients receiving lenvatinib had a median progression-free survival (PFS) and overall survival (OS) of 3.7 months (95% CI 1.8-7.4) vs 6.5 months (95% CI 5.6-7.4) and 6.8 months (95% CI 2.6-10.3) vs 13.3 months (95% CI 11.6-16.1), respectively. CP-B patients receiving sorafenib had a median PFS and OS of only 0.5 months (95% CI 0.1-3.6) and 4.5 months (95% CI 2.9-6.1, respectively. Lenvatinib showed no new safety signals in CP-B patients.

Study details: This post hoc analysis included patients with uHCC from the REFLECT trial whose liver function deteriorated to CP-B or remained CP-A within 8 weeks of randomization to lenvatinib (CP-B: n = 60; CP-A: n = 413) or sorafenib (CP-B: n = 47; CP-A: n = 427).

Disclosures: This study was funded by Eisai Inc. and Merck Sharp & Dohme (MSD) LLC. Some authors declared serving as speakers, consultants, or advisors for various organizations, including Eisai and MSD.

Source: Huynh J et al. Lenvatinib in patients with unresectable hepatocellular carcinoma who progressed to Child-Pugh B liver function. Ther Adv Med Oncol. 2022;14:17588359221116608 (Aug 24). Doi: 10.1177/17588359221116608

Key clinical point: Lenvatinib may continue to benefit patients with unresectable hepatocellular carcinoma (uHCC) despite liver function deterioration to Child-Pugh class B (CP-B) after therapy initiation.

Major finding: CP-B vs CP-A patients receiving lenvatinib had a median progression-free survival (PFS) and overall survival (OS) of 3.7 months (95% CI 1.8-7.4) vs 6.5 months (95% CI 5.6-7.4) and 6.8 months (95% CI 2.6-10.3) vs 13.3 months (95% CI 11.6-16.1), respectively. CP-B patients receiving sorafenib had a median PFS and OS of only 0.5 months (95% CI 0.1-3.6) and 4.5 months (95% CI 2.9-6.1, respectively. Lenvatinib showed no new safety signals in CP-B patients.

Study details: This post hoc analysis included patients with uHCC from the REFLECT trial whose liver function deteriorated to CP-B or remained CP-A within 8 weeks of randomization to lenvatinib (CP-B: n = 60; CP-A: n = 413) or sorafenib (CP-B: n = 47; CP-A: n = 427).

Disclosures: This study was funded by Eisai Inc. and Merck Sharp & Dohme (MSD) LLC. Some authors declared serving as speakers, consultants, or advisors for various organizations, including Eisai and MSD.

Source: Huynh J et al. Lenvatinib in patients with unresectable hepatocellular carcinoma who progressed to Child-Pugh B liver function. Ther Adv Med Oncol. 2022;14:17588359221116608 (Aug 24). Doi: 10.1177/17588359221116608

Key clinical point: Sintilimab plus IBI305 (a bevacizumab biosimilar) exhibits a promising efficacy and safety profile in patients with advanced hepatocellular carcinoma (HCC).

Major finding: After a median follow-up of 17.8 months, the overall response rate was 34.0% (95% CI 20.0%-48.0%) and the median progression-free survival and overall survival were 10.5 months (95% CI 8.3-12.7 months) and 20.2 months (95% CI 16.1-24.3 months), respectively. The grade 3-5 adverse event rate was 20.0%.

Study details: Findings are from a single-center phase 1b clinical trial that included 50 patients with advanced HCC who received sintilimab plus IBI305 every 3 weeks.

Disclosures: This study was partly supported by the Non-profit Central Research Institution Fund of the Chinese Academy of Medical Sciences. The authors declared no conflicts of interest.

Source: Zhang W et al. Serum concentration of CD137 and tumor infiltration by M1 macrophages predict the response to sintilimab plus bevacizumab biosimilar in advanced hepatocellular carcinoma patients. Clin Cancer Res. 2022;28(16):3499-3508 (Aug 15). Doi: 10.1158/1078-0432.CCR-21-3972

Key clinical point: Sintilimab plus IBI305 (a bevacizumab biosimilar) exhibits a promising efficacy and safety profile in patients with advanced hepatocellular carcinoma (HCC).

Major finding: After a median follow-up of 17.8 months, the overall response rate was 34.0% (95% CI 20.0%-48.0%) and the median progression-free survival and overall survival were 10.5 months (95% CI 8.3-12.7 months) and 20.2 months (95% CI 16.1-24.3 months), respectively. The grade 3-5 adverse event rate was 20.0%.

Study details: Findings are from a single-center phase 1b clinical trial that included 50 patients with advanced HCC who received sintilimab plus IBI305 every 3 weeks.

Disclosures: This study was partly supported by the Non-profit Central Research Institution Fund of the Chinese Academy of Medical Sciences. The authors declared no conflicts of interest.

Source: Zhang W et al. Serum concentration of CD137 and tumor infiltration by M1 macrophages predict the response to sintilimab plus bevacizumab biosimilar in advanced hepatocellular carcinoma patients. Clin Cancer Res. 2022;28(16):3499-3508 (Aug 15). Doi: 10.1158/1078-0432.CCR-21-3972

Key clinical point: Sintilimab plus IBI305 (a bevacizumab biosimilar) exhibits a promising efficacy and safety profile in patients with advanced hepatocellular carcinoma (HCC).

Major finding: After a median follow-up of 17.8 months, the overall response rate was 34.0% (95% CI 20.0%-48.0%) and the median progression-free survival and overall survival were 10.5 months (95% CI 8.3-12.7 months) and 20.2 months (95% CI 16.1-24.3 months), respectively. The grade 3-5 adverse event rate was 20.0%.

Study details: Findings are from a single-center phase 1b clinical trial that included 50 patients with advanced HCC who received sintilimab plus IBI305 every 3 weeks.

Disclosures: This study was partly supported by the Non-profit Central Research Institution Fund of the Chinese Academy of Medical Sciences. The authors declared no conflicts of interest.

Source: Zhang W et al. Serum concentration of CD137 and tumor infiltration by M1 macrophages predict the response to sintilimab plus bevacizumab biosimilar in advanced hepatocellular carcinoma patients. Clin Cancer Res. 2022;28(16):3499-3508 (Aug 15). Doi: 10.1158/1078-0432.CCR-21-3972

Liver transplantation has the opportunity to cure both localized HCC as well as underlying liver cirrhosis. Donor organ shortage has led to the implementation of the Milan criteria as a way to identify patients whose tumor burden is low enough to predict a good outcome. Downstaging liver cancer to fit within Milan criteria has been controversial.

Tabrizian and colleagues undertook a retrospective cohort analysis of 2645 adult patients with HCC who underwent liver transplant. Out of those, 2122 patients always had disease that was within the Milan criteria, 341 patients had HCC that was downstaged to fit within the Milan criteria, and 182 patients had HCC that was outside the Milan criteria at the time of liver transplantation. The authors report that the 10-year post-transplant survival and recurrence rates were 61.5% and 13.3%, respectively, in those always within the Milan criteria, 52.1% and 20.6% among those whose disease was downstaged, and 43.3% and 41.1% in those whose disease was never downstaged. Characteristics that predicted recurrence after downstaging were tumor size > 7 cm at diagnosis (odds ratio [OR] 2.62; 95% CI 1.20-5.75; P = .02), more than three tumors at diagnosis (OR 2.34; 95% CI 1.22-4.50; P = .01), and alpha-fetoprotein (AFP) response ≥ 20 ng/mL with < 50% improvement from maximum AFP before transplantation (OR 1.99; 95% CI 1.14-3.46; P = .02). Additionally, patients with recurrent tumors that were surgically resected had improved 5-year post-recurrence survival (31.6% vs 7.3%; P < .001). The conclusion was that the national downstaging policies were valid and should continue.

For patients who have unresectable HCC, systemic therapy is the mainstay of treatment. Peng and colleagues reported the results of the LAUNCH phase 3 clinical trial that randomized patients to receive lenvatinib alone or lenvatinib plus transarterial chemoembolization (TACE). Out of 338 patients, 170 received lenvatinib plus TACE. Unsurprisingly, the response rate was higher with the combination (54.1% vs 25.0%; P < .001); however, so was the median overall survival (17.8 vs 11.5 months; hazard ratio 0.45; P < .001), and median progression-free survival (10.6 vs 6.4 months; hazard ratio 0.43; P < .001). The investigators concluded that the addition of TACE to lenvatinib had manageable toxicities, improved clinical outcomes, and could be used as a potential first-line treatment for some patients with unresectable HCC.

Finally, in patients whose HCC progressed after a single TACE treatment, the question remains whether repeated TACE is worthwhile. Zhao and colleagues retrospectively reviewed the outcomes of 94 patients who underwent at least one TACE. Of these, 28 (29.8%) had a response to the first TACE, and these patients tended to have a longer OS compared with nonresponders (36.7 vs 21.5 months; P = .071). Of the 43 initial nonresponders who underwent a second TACE, 15 of 43 (34.9%) achieved a response and had an improved median overall survival (47.8 v. 13.6 months; P = .01), suggesting that repeat TACE may offer a benefit to some patients, even after no response to the initial treatment.

Liver transplantation has the opportunity to cure both localized HCC as well as underlying liver cirrhosis. Donor organ shortage has led to the implementation of the Milan criteria as a way to identify patients whose tumor burden is low enough to predict a good outcome. Downstaging liver cancer to fit within Milan criteria has been controversial.

Tabrizian and colleagues undertook a retrospective cohort analysis of 2645 adult patients with HCC who underwent liver transplant. Out of those, 2122 patients always had disease that was within the Milan criteria, 341 patients had HCC that was downstaged to fit within the Milan criteria, and 182 patients had HCC that was outside the Milan criteria at the time of liver transplantation. The authors report that the 10-year post-transplant survival and recurrence rates were 61.5% and 13.3%, respectively, in those always within the Milan criteria, 52.1% and 20.6% among those whose disease was downstaged, and 43.3% and 41.1% in those whose disease was never downstaged. Characteristics that predicted recurrence after downstaging were tumor size > 7 cm at diagnosis (odds ratio [OR] 2.62; 95% CI 1.20-5.75; P = .02), more than three tumors at diagnosis (OR 2.34; 95% CI 1.22-4.50; P = .01), and alpha-fetoprotein (AFP) response ≥ 20 ng/mL with < 50% improvement from maximum AFP before transplantation (OR 1.99; 95% CI 1.14-3.46; P = .02). Additionally, patients with recurrent tumors that were surgically resected had improved 5-year post-recurrence survival (31.6% vs 7.3%; P < .001). The conclusion was that the national downstaging policies were valid and should continue.

For patients who have unresectable HCC, systemic therapy is the mainstay of treatment. Peng and colleagues reported the results of the LAUNCH phase 3 clinical trial that randomized patients to receive lenvatinib alone or lenvatinib plus transarterial chemoembolization (TACE). Out of 338 patients, 170 received lenvatinib plus TACE. Unsurprisingly, the response rate was higher with the combination (54.1% vs 25.0%; P < .001); however, so was the median overall survival (17.8 vs 11.5 months; hazard ratio 0.45; P < .001), and median progression-free survival (10.6 vs 6.4 months; hazard ratio 0.43; P < .001). The investigators concluded that the addition of TACE to lenvatinib had manageable toxicities, improved clinical outcomes, and could be used as a potential first-line treatment for some patients with unresectable HCC.

Finally, in patients whose HCC progressed after a single TACE treatment, the question remains whether repeated TACE is worthwhile. Zhao and colleagues retrospectively reviewed the outcomes of 94 patients who underwent at least one TACE. Of these, 28 (29.8%) had a response to the first TACE, and these patients tended to have a longer OS compared with nonresponders (36.7 vs 21.5 months; P = .071). Of the 43 initial nonresponders who underwent a second TACE, 15 of 43 (34.9%) achieved a response and had an improved median overall survival (47.8 v. 13.6 months; P = .01), suggesting that repeat TACE may offer a benefit to some patients, even after no response to the initial treatment.

Liver transplantation has the opportunity to cure both localized HCC as well as underlying liver cirrhosis. Donor organ shortage has led to the implementation of the Milan criteria as a way to identify patients whose tumor burden is low enough to predict a good outcome. Downstaging liver cancer to fit within Milan criteria has been controversial.

Tabrizian and colleagues undertook a retrospective cohort analysis of 2645 adult patients with HCC who underwent liver transplant. Out of those, 2122 patients always had disease that was within the Milan criteria, 341 patients had HCC that was downstaged to fit within the Milan criteria, and 182 patients had HCC that was outside the Milan criteria at the time of liver transplantation. The authors report that the 10-year post-transplant survival and recurrence rates were 61.5% and 13.3%, respectively, in those always within the Milan criteria, 52.1% and 20.6% among those whose disease was downstaged, and 43.3% and 41.1% in those whose disease was never downstaged. Characteristics that predicted recurrence after downstaging were tumor size > 7 cm at diagnosis (odds ratio [OR] 2.62; 95% CI 1.20-5.75; P = .02), more than three tumors at diagnosis (OR 2.34; 95% CI 1.22-4.50; P = .01), and alpha-fetoprotein (AFP) response ≥ 20 ng/mL with < 50% improvement from maximum AFP before transplantation (OR 1.99; 95% CI 1.14-3.46; P = .02). Additionally, patients with recurrent tumors that were surgically resected had improved 5-year post-recurrence survival (31.6% vs 7.3%; P < .001). The conclusion was that the national downstaging policies were valid and should continue.

For patients who have unresectable HCC, systemic therapy is the mainstay of treatment. Peng and colleagues reported the results of the LAUNCH phase 3 clinical trial that randomized patients to receive lenvatinib alone or lenvatinib plus transarterial chemoembolization (TACE). Out of 338 patients, 170 received lenvatinib plus TACE. Unsurprisingly, the response rate was higher with the combination (54.1% vs 25.0%; P < .001); however, so was the median overall survival (17.8 vs 11.5 months; hazard ratio 0.45; P < .001), and median progression-free survival (10.6 vs 6.4 months; hazard ratio 0.43; P < .001). The investigators concluded that the addition of TACE to lenvatinib had manageable toxicities, improved clinical outcomes, and could be used as a potential first-line treatment for some patients with unresectable HCC.

Finally, in patients whose HCC progressed after a single TACE treatment, the question remains whether repeated TACE is worthwhile. Zhao and colleagues retrospectively reviewed the outcomes of 94 patients who underwent at least one TACE. Of these, 28 (29.8%) had a response to the first TACE, and these patients tended to have a longer OS compared with nonresponders (36.7 vs 21.5 months; P = .071). Of the 43 initial nonresponders who underwent a second TACE, 15 of 43 (34.9%) achieved a response and had an improved median overall survival (47.8 v. 13.6 months; P = .01), suggesting that repeat TACE may offer a benefit to some patients, even after no response to the initial treatment.

Liver transplantation has the opportunity to cure both localized HCC as well as underlying liver cirrhosis. Donor organ shortage has led to the implementation of the Milan criteria as a way to identify patients whose tumor burden is low enough to predict a good outcome. Downstaging liver cancer to fit within Milan criteria has been controversial.

Tabrizian and colleagues undertook a retrospective cohort analysis of 2645 adult patients with HCC who underwent liver transplant. Out of those, 2122 patients always had disease that was within the Milan criteria, 341 patients had HCC that was downstaged to fit within the Milan criteria, and 182 patients had HCC that was outside the Milan criteria at the time of liver transplantation. The authors report that the 10-year post-transplant survival and recurrence rates were 61.5% and 13.3%, respectively, in those always within the Milan criteria, 52.1% and 20.6% among those whose disease was downstaged, and 43.3% and 41.1% in those whose disease was never downstaged. Characteristics that predicted recurrence after downstaging were tumor size > 7 cm at diagnosis (odds ratio [OR] 2.62; 95% CI 1.20-5.75; P = .02), more than three tumors at diagnosis (OR 2.34; 95% CI 1.22-4.50; P = .01), and alpha-fetoprotein (AFP) response ≥ 20 ng/mL with < 50% improvement from maximum AFP before transplantation (OR 1.99; 95% CI 1.14-3.46; P = .02). Additionally, patients with recurrent tumors that were surgically resected had improved 5-year post-recurrence survival (31.6% vs 7.3%; P < .001). The conclusion was that the national downstaging policies were valid and should continue.

For patients who have unresectable HCC, systemic therapy is the mainstay of treatment. Peng and colleagues reported the results of the LAUNCH phase 3 clinical trial that randomized patients to receive lenvatinib alone or lenvatinib plus transarterial chemoembolization (TACE). Out of 338 patients, 170 received lenvatinib plus TACE. Unsurprisingly, the response rate was higher with the combination (54.1% vs 25.0%; P < .001); however, so was the median overall survival (17.8 vs 11.5 months; hazard ratio 0.45; P < .001), and median progression-free survival (10.6 vs 6.4 months; hazard ratio 0.43; P < .001). The investigators concluded that the addition of TACE to lenvatinib had manageable toxicities, improved clinical outcomes, and could be used as a potential first-line treatment for some patients with unresectable HCC.

Finally, in patients whose HCC progressed after a single TACE treatment, the question remains whether repeated TACE is worthwhile. Zhao and colleagues retrospectively reviewed the outcomes of 94 patients who underwent at least one TACE. Of these, 28 (29.8%) had a response to the first TACE, and these patients tended to have a longer OS compared with nonresponders (36.7 vs 21.5 months; P = .071). Of the 43 initial nonresponders who underwent a second TACE, 15 of 43 (34.9%) achieved a response and had an improved median overall survival (47.8 v. 13.6 months; P = .01), suggesting that repeat TACE may offer a benefit to some patients, even after no response to the initial treatment.

Liver transplantation has the opportunity to cure both localized HCC as well as underlying liver cirrhosis. Donor organ shortage has led to the implementation of the Milan criteria as a way to identify patients whose tumor burden is low enough to predict a good outcome. Downstaging liver cancer to fit within Milan criteria has been controversial.

Tabrizian and colleagues undertook a retrospective cohort analysis of 2645 adult patients with HCC who underwent liver transplant. Out of those, 2122 patients always had disease that was within the Milan criteria, 341 patients had HCC that was downstaged to fit within the Milan criteria, and 182 patients had HCC that was outside the Milan criteria at the time of liver transplantation. The authors report that the 10-year post-transplant survival and recurrence rates were 61.5% and 13.3%, respectively, in those always within the Milan criteria, 52.1% and 20.6% among those whose disease was downstaged, and 43.3% and 41.1% in those whose disease was never downstaged. Characteristics that predicted recurrence after downstaging were tumor size > 7 cm at diagnosis (odds ratio [OR] 2.62; 95% CI 1.20-5.75; P = .02), more than three tumors at diagnosis (OR 2.34; 95% CI 1.22-4.50; P = .01), and alpha-fetoprotein (AFP) response ≥ 20 ng/mL with < 50% improvement from maximum AFP before transplantation (OR 1.99; 95% CI 1.14-3.46; P = .02). Additionally, patients with recurrent tumors that were surgically resected had improved 5-year post-recurrence survival (31.6% vs 7.3%; P < .001). The conclusion was that the national downstaging policies were valid and should continue.

For patients who have unresectable HCC, systemic therapy is the mainstay of treatment. Peng and colleagues reported the results of the LAUNCH phase 3 clinical trial that randomized patients to receive lenvatinib alone or lenvatinib plus transarterial chemoembolization (TACE). Out of 338 patients, 170 received lenvatinib plus TACE. Unsurprisingly, the response rate was higher with the combination (54.1% vs 25.0%; P < .001); however, so was the median overall survival (17.8 vs 11.5 months; hazard ratio 0.45; P < .001), and median progression-free survival (10.6 vs 6.4 months; hazard ratio 0.43; P < .001). The investigators concluded that the addition of TACE to lenvatinib had manageable toxicities, improved clinical outcomes, and could be used as a potential first-line treatment for some patients with unresectable HCC.

Finally, in patients whose HCC progressed after a single TACE treatment, the question remains whether repeated TACE is worthwhile. Zhao and colleagues retrospectively reviewed the outcomes of 94 patients who underwent at least one TACE. Of these, 28 (29.8%) had a response to the first TACE, and these patients tended to have a longer OS compared with nonresponders (36.7 vs 21.5 months; P = .071). Of the 43 initial nonresponders who underwent a second TACE, 15 of 43 (34.9%) achieved a response and had an improved median overall survival (47.8 v. 13.6 months; P = .01), suggesting that repeat TACE may offer a benefit to some patients, even after no response to the initial treatment.

Liver transplantation has the opportunity to cure both localized HCC as well as underlying liver cirrhosis. Donor organ shortage has led to the implementation of the Milan criteria as a way to identify patients whose tumor burden is low enough to predict a good outcome. Downstaging liver cancer to fit within Milan criteria has been controversial.

Tabrizian and colleagues undertook a retrospective cohort analysis of 2645 adult patients with HCC who underwent liver transplant. Out of those, 2122 patients always had disease that was within the Milan criteria, 341 patients had HCC that was downstaged to fit within the Milan criteria, and 182 patients had HCC that was outside the Milan criteria at the time of liver transplantation. The authors report that the 10-year post-transplant survival and recurrence rates were 61.5% and 13.3%, respectively, in those always within the Milan criteria, 52.1% and 20.6% among those whose disease was downstaged, and 43.3% and 41.1% in those whose disease was never downstaged. Characteristics that predicted recurrence after downstaging were tumor size > 7 cm at diagnosis (odds ratio [OR] 2.62; 95% CI 1.20-5.75; P = .02), more than three tumors at diagnosis (OR 2.34; 95% CI 1.22-4.50; P = .01), and alpha-fetoprotein (AFP) response ≥ 20 ng/mL with < 50% improvement from maximum AFP before transplantation (OR 1.99; 95% CI 1.14-3.46; P = .02). Additionally, patients with recurrent tumors that were surgically resected had improved 5-year post-recurrence survival (31.6% vs 7.3%; P < .001). The conclusion was that the national downstaging policies were valid and should continue.

For patients who have unresectable HCC, systemic therapy is the mainstay of treatment. Peng and colleagues reported the results of the LAUNCH phase 3 clinical trial that randomized patients to receive lenvatinib alone or lenvatinib plus transarterial chemoembolization (TACE). Out of 338 patients, 170 received lenvatinib plus TACE. Unsurprisingly, the response rate was higher with the combination (54.1% vs 25.0%; P < .001); however, so was the median overall survival (17.8 vs 11.5 months; hazard ratio 0.45; P < .001), and median progression-free survival (10.6 vs 6.4 months; hazard ratio 0.43; P < .001). The investigators concluded that the addition of TACE to lenvatinib had manageable toxicities, improved clinical outcomes, and could be used as a potential first-line treatment for some patients with unresectable HCC.

Finally, in patients whose HCC progressed after a single TACE treatment, the question remains whether repeated TACE is worthwhile. Zhao and colleagues retrospectively reviewed the outcomes of 94 patients who underwent at least one TACE. Of these, 28 (29.8%) had a response to the first TACE, and these patients tended to have a longer OS compared with nonresponders (36.7 vs 21.5 months; P = .071). Of the 43 initial nonresponders who underwent a second TACE, 15 of 43 (34.9%) achieved a response and had an improved median overall survival (47.8 v. 13.6 months; P = .01), suggesting that repeat TACE may offer a benefit to some patients, even after no response to the initial treatment.

Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.

Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P  =  .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P  =  .701).

Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.

Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.

Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615

Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.

Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P  =  .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P  =  .701).

Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.

Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.

Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615

Key clinical point: A single session of transarterial chemoembolization (TACE) may not always confer significant survival benefits in patients with intermediate-stage hepatocellular carcinoma (HCC); initial nonresponders benefit from a second TACE session.

Major finding: The overall survival of responders to the first TACE was significantly better than that of nonresponders (36.7 vs 21.5 months; P  =  .071) and comparable with that of initial nonresponders who responded to the second TACE (36.7 vs 47.8 months; P  =  .701).

Study details: This retrospective study reviewed the data of 94 patients with intermediate-stage HCC who underwent TACE and magnetic resonance imaging before and after TACE.

Disclosures: This study was sponsored by the US National Institutes of Health/National Cancer Institute and Philips Research North America (PRNA), Cambridge, USA. Some authors reported being advisory board members or consultants for or receiving research grants from various sources. MD Lin is a former employee of PRNA.

Source: Zhao Y et al. Three-dimensional quantitative tumor response and survival analysis of hepatocellular carcinoma patients who failed initial transarterial chemoembolization: Repeat or switch treatment? Cancers (Basel). 2022;14(15):3615 (Jul 25). Doi: 10.3390/cancers14153615

Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.

Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P  =  .036) and longer median progression-free survival (10.4 vs 6.3 months; P  =  .015) and overall survival (13.8 vs 8.8 months; P  =  .013), with 12 patients vs none experiencing successful downstaging.

Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).

Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.

Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi:  10.3390/cancers14153619

Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.

Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P  =  .036) and longer median progression-free survival (10.4 vs 6.3 months; P  =  .015) and overall survival (13.8 vs 8.8 months; P  =  .013), with 12 patients vs none experiencing successful downstaging.

Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).

Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.

Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi:  10.3390/cancers14153619

Key clinical point: The combination of sorafenib, an immune checkpoint inhibitor (camrelizumab/tislelizumab), transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SITS) is more effective than sorafenib plus TACE (ST) in advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT), especially as a downstaging strategy.

Major finding: The SITS vs ST group had a significantly higher objective response rate (53.3% vs 25.0%; P  =  .036) and longer median progression-free survival (10.4 vs 6.3 months; P  =  .015) and overall survival (13.8 vs 8.8 months; P  =  .013), with 12 patients vs none experiencing successful downstaging.

Study details: Findings are from a retrospective study including 62 patients with advanced HCC and PVTT who received SITS (n = 30) or ST (n = 32).

Disclosures: This study was supported by the Hubei Chen Xiaoping Science and Technology Development Foundation, China, and the Autonomous Exploration and Innovation Fund Subject for Graduate Student of Central South University, China. The authors declared no conflicts of interest.

Source: Zhang Z et al. A Combination of sorafenib, an immune checkpoint inhibitor, TACE and stereotactic body radiation therapy versus sorafenib and TACE in advanced hepatocellular carcinoma accompanied by portal vein tumor thrombus. Cancers (Basel). 2022;14(15):3619 (Jul 25). Doi:  10.3390/cancers14153619

Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.

Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).

Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.

Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.

Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1

Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.

Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).

Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.

Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.

Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1

Key clinical point: Percutaneous no-touch radiofrequency ablation (NtRFA) provides effective tumor control in the treatment of hepatocellular carcinoma (HCC) ≤5 cm, with a lower local tumor progression (LTP) rate than that with conventional RFA.

Major finding: NtRFA offered a pooled overall LTP rate of 6% (95% CI 4%-8%) and significantly lower LTP rates compared with conventional RFA (hazard ratio 0.28; relative risk 0.26; both P < .01).

Study details: This was a meta-analysis of 12 studies that included 900 patients and evaluated LTP after NtRFA for HCC ≤5 cm.

Disclosures: This study was supported by a Korea Medical Device Development Fund grant funded by the Korea government. The authors declared no conflicts of interest.

Source: Kim TH et al. Can “no-touch” radiofrequency ablation for hepatocellular carcinoma improve local tumor control? Systematic review and meta-analysis. Eur Radiol. 2022 (Jul 30). Doi: 10.1007/s00330-022-08991-1

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215

Key clinical point: Improved survival among children vs adults with hepatocellular carcinoma (HCC) despite greater fibrolamellar histology prevalence and positive lymph node number and similar metastasis rates is a likely result of a more aggressive surgical approach.

Major finding: Although children vs adults had a higher prevalence of fibrolamellar HCC (32% vs 9%) and number of positive lymph nodes (35% vs 17%; P  =  .02) and comparable metastasis rates (30% vs 28%; P  =  .47), they had significantly better 1-year (81% vs 70%) and 5-year (55% vs 48%) overall survival and surgical intervention (74% vs 62%) rates (all P < .001).

Study details: This study stratified the data of 1520 patients with grade ≥1 HCC from the National Cancer Database by age: <21 years (children; n = 244) and 21-40 years (young adults; n = 1276).

Disclosures: No source of funding was reported. SJ Commander declared receiving financial support from several sources.

Source: Commander SJ et al. Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Int J Cancer. 2022 (Jul 16). Doi:  10.1002/ijc.34215