Feasibility, safety, and outcome of second-line nivolumab/bevacizumab in liver transplant patients with recurrent hepatocellular carcinoma

Marco, Luigi Di; Pivetti, Alessandra; Foschi, Francesco Giuseppe; D’Amico, Roberto; Schepis, Filippo; Caporali, Cristian; Casari, Federico; Lasagni, Simone; Critelli, Rosina Maria; Milosa, Fabiola; Romanzi, Adriana; Marcelli, Gemma; Maria, Nicola De; Romagnoli, Dante; Catellani, Barbara; Scianò, Filippo; Magistri, Paolo; Colecchia, Antonio; Sighinolfi, Pamela; Benedetto, Fabrizio Di; Martínez-Chantar, María-Luz; Villa, Erica

doi:10.1097/lvt.0000000000000087

Cited by 11 publications

(7 citation statements)

References 5 publications

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“…2 Recent works reported that immune checkpoint inhibitors (ICI) demonstrated better outcomes over the standard treatment with sorafenib in terms of overall and progression-free survival in patients with advanced HCC. 3,4 We all agree that ICIs are the present and future of multidisciplinary HCC treatment; however, they became available in this setting only after 2020. Patients included in our study underwent surgery between 2010 and 2020 as reported in the Methods; therefore, they could not have access to ICI protocols for neoadjuvant treatments.…”

Section: Published Onlinementioning

confidence: 90%

“…Moreover, the HCC prognosis will be impacted by the presence of distant metastasis. 4 Would it be necessary to exclude patients who had distant metastasis before liver resection?…”

Section: Robotic Vs Open Liver Resection For Hepatocellular Carcinomamentioning

confidence: 99%

“…So far, prospective randomized clinical trials on the management of cN1b PTC have not been done. 3,4 Therefore, we conducted this retrospective cohort study using propensity score matching to minimize the influence of related factors. Owing to the retrospective nature of these data, the sample size of the study cannot be calculated in advance but instead reflects the number of patients meeting eligibility criteria.…”

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confidence: 99%

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Robotic vs Open Liver Resection for Hepatocellular Carcinoma

Huang

2023

JAMA Surg

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To the Editor With great interest, I read the article by Di Benedetto et al, 1 which was recently published in JAMA Surgery. Di Benedetto et al 1 analyzed the short-and longterm outcomes of robotic liver resection (RLR) for hepatocellular carcinoma from Western high-volume centers to assess the safety, reproducibility, and oncological efficacy of this technique. They concluded that, compared with open liver resection (OLR), RLR performed in tertiary centers represents a safe treatment strategy for patients with hepatocellular carcinoma and those with compromised liver function while achieving oncologic efficacy. However, I would like to discuss a few concerns about this article and demonstrate that this information is not clinically usable and can be misleading.First, this is a multicenter and retrospective study, and propensity score matching was used to keep the 2 groups comparable; however, this study was nonrandomized and nonblinded. This may result in some patients with tumors close to important blood vessels of the liver, specifically those located near the hepatic portal vein and inferior vena cava, being more inclined to choose OLR as it requires major vascular resection and reconstruction. Furthermore, differences in microvascular invasion were observed between the 2 groups, which is an important factor influencing patient recurrence and leading patients in the OLR group to be more prone to recurrence even after propensity score matching. More than 90% of patients in the study cohort had no portal hypertension, and only 5% of patients had Child-Pugh class B; these so-called ideal candidates were difficult to find in a single center.Second, I observed that only 1 patient had a grade B bile leak in the total enrolled cases. Robotic visual cues are improved via the binocular-enhanced 3-dimensional vision despite missing tactile feedback, making the robotic approach

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Section: Published Onlinementioning

confidence: 90%

“…Moreover, the HCC prognosis will be impacted by the presence of distant metastasis. 4 Would it be necessary to exclude patients who had distant metastasis before liver resection?…”

Section: Robotic Vs Open Liver Resection For Hepatocellular Carcinomamentioning

confidence: 99%

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confidence: 99%

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Robotic vs Open Liver Resection for Hepatocellular Carcinoma

Huang

2023

JAMA Surg

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“…Risk factors included ICI-liver transplantation time less than 1 year, autoimmune disease, young patients with DSA, and previous rejection. While results from clinical trials are evolving, some recent data suggest that adjuvant immunotherapy may improve the prognosis of patients with recurrence post liver transplantation [54–67,68 ▪ ,69 ▪ ]. A summary of current published literature is reported on Table 3.…”

Section: Current Role Of Immunotherapy After Liver Transplantation Fo...mentioning

confidence: 99%

Immunotherapy for transplantation of hepatocellular carcinoma: the next frontier in adjunctive therapy

Tabrizian,

Zeitlhoefler,

Hassan

et al. 2023

Current Opinion in Organ Transplantation

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Purpose of review The increasing success of liver transplantation in hepatocellular carcinoma (HCC) drives an ever-evolving search for innovative strategies to broaden eligible patients’ pools. Recent advances in immuno-oncology have turned the spotlight on immune checkpoint inhibitors (ICIs). This review offers an updated overview of ICIs in liver transplantation for HCC, exploring neoadjuvant and adjuvant approaches and addressing unanswered questions on safety, patients’ selection, and response predictors. Recent findings ICIs have transitioned from being a last-chance therapeutic hope to becoming an integral cornerstone in the treatment of advanced HCC, holding great promise as a compelling option not only to downstage patients for transplantation but also as an alternative strategy in addressing posttransplantation disease recurrence. Despite ongoing refinements in immunotherapeutic agents, the complex molecular pathways involved emphasize the need for a comprehensive approach to integrate immunotherapy in liver transplantation. Summary Initial concerns about graft rejection, with ICIs as a bridging therapy to liver transplantation, were successfully addressed using adequate immunosuppressants strategies and minimized with a sufficient washout period. Post-liver transplantation disease recurrence remains challenging, requiring a balance between effective therapy and preserving graft function. Emphasis should be placed on clinical trials validating the risk-benefit ratio of ICIs for liver transplantation, guiding appropriate patients’ selection, and establishing clear management pathways.

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“…We want to clarify that all included patients underwent liver resection with a curative intent and none of them were affected by a metastatic disease, which is currently not considered a reasonable indication for surgery . Recent works reported that immune checkpoint inhibitors (ICI) demonstrated better outcomes over the standard treatment with sorafenib in terms of overall and progression-free survival in patients with advanced HCC . We all agree that ICIs are the present and future of multidisciplinary HCC treatment; however, they became available in this setting only after 2020.…”

mentioning

confidence: 99%