Immune checkpoint inhibitors: use them early, combined and instead of TACE?

Abstract

Figure 1 Schematic representation of the development in the treatment of advanced-stage HCC based on median overall survival (mOS) data from some recent trials. The arrows are proportional to the reported (grey) or hypothetical (blue) mOS indicated by the respective numbers. The green overlapping arrows represent respectively the real-world and the expected survival (ie, based on the selection of 'ideal' candidates for TACE) in BCLC-B patients. The list of trials is not exhaustive and, due to the heterogeneity of patients' population, not suitable for direct cross-comparison between the trials. Atezo/Bev: combined atezolizumab and bevacizumab; pH, phase of clinical study; TACE, trans-arterial chemoembolisation.on July 7, 2020 by guest. Protected by copyright.

Immunotherapy for advanced hepatocellular carcinoma: a focus on special subgroups

“…The combination of atezolizumab and bevacizumab will become the new reference standard in advanced HCC, and is currently being evaluated in earlier stages as adjuvant treatment after resection or ablation (NCT04102098) and in combination with transarterial chemoembolisation (NCT04224636). 89 However, patients with prior organ transplantation and uncontrolled pre-existing AID (including IBD) should not receive atezolizumab plus bevacizumab due to safety concerns, as long as there are other treatment options available. In case of mild or well-controlled AID and whenever disease flares are not life threatening, ICBs may be considered based on safety data from retrospective analyses.…”

Meta-analysis of the efficacy and safety of PD-1/PD-L1 inhibitors administered alone or in combination with anti-VEGF agents in advanced hepatocellular carcinoma

“…The combination of anti-vascular endothelial growth factor (VEGF) agents with PD‐1/PD‐L1 blockade may synergistically reverse the immunosuppressive microenvironment 5. Preclinical and preliminary clinical reports suggest that combined treatment shows improved efficacy over PD-1/PD-L1 blockade alone in aHCC 6–8. Therefore, we conducted a meta-analysis to evaluate the efficacy and safety of PD-1/PD-L1 inhibitors as a monotherapy or in combination with anti-VEGF agents in aHCC.…”

Liver transplantation versus watchful waiting in hepatocellular carcinoma patients with complete response to bridging therapy – a retrospective observational study

“…Also, immune treatment by checkpoint inhibitors has substantially modified the treatment of HCC with 10% of patients exhibiting a complete response and altogether one third of these patients experiencing a durable response. The use of these agents in regimens of combined local treatment and systemic treatment or in the adjuvant setting may further improve the recurrence rate in the CR‐WW patients [27].…”