Chinese expert consensus on neoadjuvant and conversion therapies for hepatocellular carcinoma

Abstract

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.

The Significance of Transarterial Chemo(Embolization) Combined With Tyrosine Kinase Inhibitors and Immune Checkpoint Inhibitors for Unresectable Hepatocellular Carcinoma in the Era of Systemic Therapy: A Systematic Review

“…Conversion therapy is well concerned nowadays in the field of uHCC ( 43 , 44 ). Evidence suggests that R0 resection is a crucial independent protective factor of long-term survival ( 45 ).…”

Conversion therapy with an immune checkpoint inhibitor and an antiangiogenic drug for advanced hepatocellular carcinoma: A review

“…In the treatment of HCC, conversion therapy should be distinguished from neoadjuvant therapy. Both of the two concepts are vital steps in preoperative therapy for intermediate or advanced HCC (16,18,(32)(33)(34)(35). Although there are still debates over the confusing overlap of the two concepts, the differences between conversion therapy and neoadjuvant therapy for HCC are briefly summarized in Table 2.…”

Case report: Conversion therapy to permit resection of initially unresectable hepatocellular carcinoma

“…Unfortunately, about 70% of HCC patients are diagnosed at an advanced stage of the disease and are therefore ineligible for surgery ( 2 ). Recently, so-called “conversion therapies” have been described that can improve unresectable HCC enough that the patient can undergo resection, leading to much better prognosis ( 3 , 4 ).…”

“…Several types of conversion therapy have been described, most often involving transarterial chemoembolization (TACE) ( 3 ). Immune checkpoint inhibitor (ICIs) and tyrosine kinase inhibitors (TKIs) have also proven promising for treating advanced HCC, alone and together ( 5 , 6 ).…”