Expanded use of aggressive therapies improves survival in early and intermediate hepatocellular carcinoma

Abstract

As one of few studies to track the complete course of sequential HCC therapies, the findings of the present study suggest that HCC patients with intermediate-stage (BCLC stage B) disease may benefit from aggressive interventions not currently included in societal guidelines.

Phase III HEAT Study Adding Lyso-Thermosensitive Liposomal Doxorubicin to Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Lesions

“…Although ablation is generally not recommended in intermediate-size HCC, it can be considered in select cases (27). Recent studies and newly developed guidelines have suggested that curative interventions should be further considered in patients with intermediate-size HCC due to the heterogeneity of the group (3,28). Concerns regarding the limits of RFA in larger tumors include the high rates of incomplete ablations and the potential for thermal injury (29).…”

Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

“…However, increasing evidence suggests that the BCLC system is an imperfect tool in selecting the best treatment option for HCC, and the advancements in HCC management prompts the refinement of an algorithm created more than 10 years ago. The current inadequacy of the BCLC staging system is widely perceived so that both Japanese and Italian guidelines propose, instead of a single stage‐specific first‐line treatment, a “box” of therapeutic options allowing a more flexible and individualized decision, and a number of referral centres report frequent deviations from the BCLC indications . The therapeutic boundaries are perceived as especially narrow for the intermediate stage (BCLC B), which includes an extremely heterogeneous population so that the standard‐of‐care treatment –transarterial chemoembolization (TACE) – may represent an “undertreatment” for some patients and an “overtreatment” for others.…”

Heterogeneity of intermediate-stage HCC necessitates personalized management including surgery

“…We disagree with this stance, as studies in both Eastern and Western countries have indicated that hepatic resection is safe and results in longer survival in selected patients with inter mediate-stage HCC as compared with TACE and/or sorafenib therapy. 2,3 The current definition of intermediatestage (BCLC B) HCC is extensive multifocal disease without vascular invasion or extrahepatic spread in patients with preserved liver function and no cancer-related symptoms ( Figure 1). The BCLC staging system is endorsed by the American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver (EASL) and the European Organisation for Research and Treatment of Cancer (EORTC), and therefore, these organizations do not advocate hepatic resection in patients with BCLC B stage HCC.…”