174P A real-world study of PD-1 inhibitors combined with TKIs for HCC with major vascular invasion as the conversion therapy: A prospective, non-randomized, open-label cohort study

Zhang, W.; Hu, Baocheng; Han, Jun; Wang, H.; Wang, Z.; Ye, H.; Ma, Guangyu; Chen, M.; Cai, Shouwang; Wang, X.; Cao, Junning; Yan, Cheng; Lu, Shichun

doi:10.1016/j.annonc.2020.10.195

Cited by 15 publications

(13 citation statements)

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“…To date, numerous explorative studies on conversion therapy have been performed, of which the treatment regimens include local therapy[ 31 - 36 ], systemic therapy[ 37 ], and combination therapy[ 38 - 42 ] (Table 3 ). Concerning the absence of a potent systemic treatment, TACE is the major method for conversion therapy[ 1 ].…”

Section: Strategies For Conducting Conversion Therapymentioning

confidence: 99%

Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma

Zhao¹,

Cai²

2021

WJG

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The low resection and high recurrence rates in hepatocellular carcinoma (HCC) are the major challenges to improving prognosis. Neoadjuvant and conversion therapies are underlying strategies to overcome these challenges. To date, no guideline or consensus has been published on the neoadjuvant and conversion therapies in HCC. Recent studies showed that neoadjuvant therapy for resectable HCC and conversion therapy for unresectable HCC are safe, feasible, and effective. Neoadjuvant and conversion therapies have the following advantages in treating HCC: R0 resection with sufficient volume of future liver remnant, relatively simple operation, and wide applicability. Therefore, it was necessary to conduct a widely accepted consensus among the experts in China who have extensive expertise and experience in treating HCC using neoadjuvant and conversion therapies, which is important to standardize the application of neoadjuvant and conversion therapies for the management of HCC. The strategies of neoadjuvant therapy include the selection of the eligible patients, therapy regimen, cycles, effect evaluations, and multidisciplinary treatment. The management of patients with insufficient volume of future liver remnant and patients who cannot achieve R0 resection is the key to the strategies of conversion therapy. Here, we present the resultant evidence- and experience-based consensus to guide the application of neoadjuvant and conversion therapies in clinical practice.

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Section: Strategies For Conducting Conversion Therapymentioning

confidence: 99%

Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma

Zhao¹,

Cai²

2021

WJG

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“…Zhu et al found the combination of TKI/anti-PD-1 antibodies was a feasible conversion therapy for patients with unresectable HCC to become resectable (13). A prospective clinical registration study (ChiCTR1900023914) also found that patients who were treated with PD-1 inhibitors plus TKI were successfully converted and subsequently underwent surgery (8)(9)(10). Therefore, we conducted a preliminary study on the relationship between parameters of pretreatment 18 F-FDG PET and pathological treatment response.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the combination of lenvatinib with pembrolizumab or nivolumab showed objective response rates (ORRs) of 36% and 54.2%, respectively (6,7). Another surprising discovery was that some patients who received ICI plus TKI as a conversion therapy retrieved the opportunity of surgery (8)(9)(10)(11)(12)(13)(14). 18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) is generally used for diagnosis, staging, and monitoring treatment of cancers, but shows poor sensitivity for the detection of HCC compared with other solid tumors (15).…”

Section: Introductionmentioning

confidence: 99%

Pretreatment Metabolic Parameters Measured by 18F-FDG PET to Predict the Pathological Treatment Response of HCC Patients Treated With PD-1 Inhibitors and Lenvatinib as a Conversion Therapy in BCLC Stage C

Wang¹,

Zhang

Chen

et al. 2022

Front. Oncol.

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ObjectivesThis study aimed to assess the pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) as a predictor of the pathological treatment response (PTR) of hepatocellular carcinoma (HCC) patients treated with PD-1 inhibitors and lenvatinib as a conversion therapy in BCLC stage C.MethodsAll patients (n=20) underwent pretreatment 18F-FDG PET/CT and were treated with conversion therapy and surgery. Patients were categorized into responders (n=9) and non-responders (n=11) according to PTR. The parameters of PET/CT, including lesion size, SUVmean (mean standard uptake value), MTV (metabolic tumor volume), TLG (total lesion glycolysis), SUVpeak (peak standard uptake value), and TLR (tumor-to-normal liver standardized uptake value ratio), were calculated. The diagnostic efficacy was evaluated by receiver operating characteristic analysis (ROC). PTR was compared with pretreatment PET/CT parameters by using Spearman correlation analysis. The patients were followed up.ResultsThere was significant difference in TLR (5.59 ± 1.90 vs. 2.84 ± 1.70, respectively; P=0.003) between responders and non-responders, with the largest area under the curve (sensitivity=100%, specificity=72.7%, AUC=0.899, 95%CI: 0.759-1.000, optimal diagnostic threshold of 3.09). The relationship between 18F-FDG PET/CT parameters and PTR indicated TLR was moderately and positively correlated with pathological treatment response, with correlation coefficients (rs) of 0.69 (P<0.01). During the follow-up, no patients died, and tumor recurrence was found in one of the responders (11.1%). In all 11 non-responders, tumor recurrence was found in six patients (54.5%) and four patients (36.4%) died.ConclusionsTLR may be a powerful marker to predict PTR of HCC patients with BCLC stage C who were treated with conversion therapy.

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“…Research shows that the tumor-free survival of patients with HCC after resection is related to the degree of pathological response, and that patients with a pathological response have longer postoperative tumor-free survival (122,124). Therefore, predicting a successful conversion is based not only on the feasibility of surgical resection, but also by assessing the degree of tumor response, which is more related to the patient's postoperative recurrence and long-term survival.…”

Section: Selection Of the Appropriate Operation Time Based On Tumor R...mentioning

confidence: 99%

“…The pathology report should record the total number of paraffin blocks from the tumor bed. Preliminary clinical evidence shows that patients with an MPR or pCR have better postoperative survival than those without an MPR or pCR (39,122,124), however, more evidence needs to be accumulated. In addition, how to predict an MPR or pCR through imaging or other clinical indicators is also an urgent problem to be solved.…”

Section: Selection Of the Appropriate Operation Time Based On Tumor R...mentioning

confidence: 99%

Chinese expert consensus on conversion therapy for hepatocellular carcinoma (2021 edition)

Sun¹,

Zhou²,

Wang³

et al. 2022

Hepatobiliary Surg Nutr

106

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Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma (HCC) have resulted in improved response rates. This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection, a 'conversion therapy' strategy. However, conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed. Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review: Many research centers in China have accumulated significant experience implementing HCC conversion therapy. Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC; however, there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields. In order to summarize and learn from past experience and review current challenges, the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma (2021 Edition) was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice. Sixteen consensus statements on the implementation of conversion therapy for HCC were developed. The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.

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174P A real-world study of PD-1 inhibitors combined with TKIs for HCC with major vascular invasion as the conversion therapy: A prospective, non-randomized, open-label cohort study

Cited by 15 publications

References 0 publications

Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma

Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma

Pretreatment Metabolic Parameters Measured by 18F-FDG PET to Predict the Pathological Treatment Response of HCC Patients Treated With PD-1 Inhibitors and Lenvatinib as a Conversion Therapy in BCLC Stage C

Chinese expert consensus on conversion therapy for hepatocellular carcinoma (2021 edition)

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