Limited tumour progression beyond Milan criteria while on the waiting list does not result in unacceptable impairment of survival

Ferrer-Fàbrega, Joana; Sampson, Jaime; Forner, Alejandro; Sapena, Víctor; Díaz, Alba; Vilana, R.; Navasa, Miquel; Fondevila, Constantino; Miquel, Rosa; Ayuso, Carmen; García‐Valdecasas, Juan Carlos; Bruix, Jordi; Reig, María; Fuster, Josep

doi:10.1016/j.jhep.2021.06.015

Cited by 15 publications

(12 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There might be different definitions for this end‐point in the real‐world practice (including RECIST 1.1, mRECIST or just progression beyond transplant criteria and the decision to delist the patient). This has been deepened in the discussion more recently 30 . In other words, we consider that patients with an expected baseline higher risk of HCC dropout are more likely at a higher risk of recurrence if transplanted.…”

Section: Discussionmentioning

confidence: 98%

“…This has been deepened in the discussion more recently. 30 In other words, we consider that patients with an expected baseline higher risk of HCC dropout are more likely at a higher risk of recurrence if transplanted. Particularly, dynamic tumour changes including PD based on RECIST 1.1 criteria after the first treatment and an AFP slope >15 ng/mL are independent risk factors for HCC dropout.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Performance of pre‐transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout

Piñero

Thompson²,

Boin

et al. 2022

Liver International

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Performance of pre‐transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout

Piñero

Thompson²,

Boin

et al. 2022

Liver International

View full text Add to dashboard Cite

show abstract

“…The current treatment recommendations for this group of patients range from liver transplant using “extended liver transplant criteria” beyond the Milan Criteria versus TACE for individuals who are not transplant candidates or systemic therapy for patients who are not TACE candidates. 15 , 17 , 18 Notably absent from this treatment algorithm is surgical resection presumably due to belief that multinodular disease assumes a prohibitive prognosis following resection. Evidence suggests, however, surgical that resection can indeed be an option for select patients with intermediate stage BCLC-B disease and may provide better survival outcomes versus TACE.…”

Section: Diagnosis and Stagingmentioning

confidence: 99%

Expert Insights on Current Treatments for Hepatocellular Carcinoma: Clinical and Molecular Approaches and Bottlenecks to Progress

Shannon¹,

Ruff²,

Pawlik³

2022

JHC

View full text Add to dashboard Cite

Hepatocellular carcinoma (HCC) is a primary liver tumor that typically occurs in the setting of chronic liver disease/cirrhosis. Treatment modalities for HCC have evolved and given the variety of treatment options, a multi-disciplinary approach requiring input from surgical, medical, and radiation oncology, hepatology, and interventional radiology is necessary. Multiple advances have been made over the last decade regarding treatment of HCC, especially advanced disease. Resection and transplantation remain as cornerstone curative-intent treatment options. For patients who are not candidates for curative-intent therapy, exciting progress has been made in molecular and cellular approaches to systemic therapy for HCC including immunotherapies and tyrosine kinase inhibitors. Although the prognosis for advanced HCC remains poor, the armamentarium of therapies has increased, and valuable years of life can be gained with these therapies. While the main therapeutic modality for early-stage disease remains resection, multimodal immunotherapy has emerged as first-line treatment for advanced disease. We herein review different clinical and molecular treatment modalities related to the treatment of HCC, as well as provide insights into future directions for HCC treatment. We highlight how research and progress are needed to move into a new era of molecular and cellular treatments.

show abstract

“…For patients within the Milan criteria, the 5‐year survival after liver transplantation was >70% with acceptable low recurrence rate <10%–15%. [ 2–4 ] However, for patients with disease beyond the Milan criteria, a growing body of literature over the past two decades supports expanding these criteria for liver transplantation [ 5–10 ] or allowing a limited progression beyond Milan criteria, [ 11 ] whereas another approach advocates using treatments to successfully “downstage” the tumor burden to within Milan criteria.…”

Section: Introductionmentioning

confidence: 99%

Hepatocellular carcinoma downstaging for liver transplantation in the era of systemic combined therapy with anti‐VEGF/TKI and immunotherapy

et al. 2022

Self Cite

View full text Add to dashboard Cite

Hepatocellular carcinoma remains a global health challenge affecting close to 1 million cases yearly. Liver transplantation provides the best long‐term outcomes for those meeting strict criteria. Efforts have been made to expand these criteria, whereas others have attempted downstaging approaches. Although locoregional approaches to downstaging are appealing and have demonstrated efficacy, limitations and challenges exists including poor imaging modality to assess response and appropriate endpoints along the process. Recent advances in systemic treatments including immune checkpoint inhibitors alone or in combination with tyrosine kinase inhibitors have prompted the discussion regarding their role for downstaging disease prior to transplantation. Here, we provide a review of prior locoregional approaches for downstaging, new systemic agents and their role for downstaging, and finally, key and critical considerations of the assessment, endpoints, and optimal designs in clinical trials to address this key question.

show abstract

Limited tumour progression beyond Milan criteria while on the waiting list does not result in unacceptable impairment of survival

Cited by 15 publications

References 31 publications

Performance of pre‐transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout

Performance of pre‐transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout

Expert Insights on Current Treatments for Hepatocellular Carcinoma: Clinical and Molecular Approaches and Bottlenecks to Progress

Hepatocellular carcinoma downstaging for liver transplantation in the era of systemic combined therapy with anti‐VEGF/TKI and immunotherapy

Contact Info

Product

Resources

About