Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies

Makary, Mina S.; Khandpur, Umang; Cloyd, Jordan M.; Mumtaz, Khalid; Dowell, Joshua D.

doi:10.3390/cancers12071914

Cited by 94 publications

(87 citation statements)

References 165 publications

(204 reference statements)

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“…However, many challenges remain, such as adequate patient selection, management of post-transplant recurrence, and refinement of neoadjuvant treatment protocols. The current literature describes multiple neoadjuvant and downstaging strategies as a bridge to LT in patients with HCC, with variable results [ 27 , 28 , 29 , 30 , 31 , 32 ]. Moreover, downstaged HCC patients with tumor burdens meeting United Network for Organ Sharing (UNOS) downstaging inclusion criteria had similar post-LT outcomes compared to patients transplanted within the Milan criteria [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Using Hepatocellular Carcinoma Tumor Burden Score to Stratify Prognosis after Liver Transplantation

Moris

Shaw

McElroy

et al. 2020

Cancers

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Liver transplantation (LT) remains a mainstay of treatment for hepatocellular carcinoma (HCC). Tumor factors such as size and number of tumors define eligibility for LT using the Milan criteria. The tumor burden score (TBS) incorporates both tumor number and size into a single continuous variable and has been used to differentiate prognosis among patients undergoing resection for HCC. The objective of the present study was to evaluate the ability of the TBS to predict overall and recurrence-free survival in patients undergoing LT for HCC. The Scientific Registry of Transplant Recipients (SRTR) was used to analyze all liver transplants for HCC, with initial tumor size data from 2004 to 2018. There were 12,486 patients in the study period. In the unadjusted analyses, patients with a high TBS had worse overall (p < 0.0001) and recurrence-free (p < 0.0001) survival. In the adjusted analyses, a high TBS was associated with a greater hazard ratio (HR) of death (HR = 1.21; 95%CI, [1.13–1.30]; p < 0.001) and recurrence (HR = 1.49; 95%CI [1.3–1.7]; p < 0.001). When we superimposed the TBS on the Milan criteria, we saw that a higher TBS was associated with a higher hazard of recurrence at values that were either all within (HR = 1.20; 95%CI, [1.04–1.37]; p = 0.011) or variably within (HR = 1.53; 95%CI, [1.16–2.01]; p = 0.002) the Milan criteria. In conclusion, the TBS is a promising tool in predicting outcomes in patients with HCC after LT.

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Section: Discussionmentioning

confidence: 99%

Using Hepatocellular Carcinoma Tumor Burden Score to Stratify Prognosis after Liver Transplantation

Moris

Shaw

McElroy

et al. 2020

Cancers

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“…While TACE is routinely used for patients with HCC[ 52 ] and neuroendocrine liver metastases[ 53 ], its appropriate use in ICC remains undefined. ICC is a hypovascular tumor and thus less responsive to TACE[ 54 , 55 ].…”

Section: Evidence For Neoadjuvant Therapy In Iccmentioning

confidence: 99%

Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma

Akateh¹,

Ejaz²,

Pawlik³

et al. 2020

WJH

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Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy and is increasing in incidence. Long-term outcomes are optimized when patients undergo margin-negative resection followed by adjuvant chemotherapy. Unfortunately, a significant proportion of patients present with locally advanced, unresectable disease. Furthermore, recurrence rates are high even among patients who undergo surgical resection. The delivery of systemic and/or liver-directed therapies prior to surgery may increase the proportion of patients who are eligible for surgery and reduce recurrence rates by prioritizing early systemic therapy for this aggressive cancer. Nevertheless, the available evidence for neoadjuvant therapy in ICC is currently limited yet recent advances in liver directed therapies, chemotherapy regimens, and targeted therapies have generated increasing interest its role. In this article, we review the rationale for, current evidence for, and ongoing research efforts in the use of neoadjuvant therapy for ICC.

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“…Therefore, various local therapeutic modalities including TACE, transcathter arterial radioembilization and HAIC, have advanced in treatment of HCC. HAIC is a traditional treatment for HCC [ 8 , 30 , 31 , 32 ]. Many studies have reported the effectiveness of HAIC for HCC [ 8 , 13 , 33 , 34 ]; however, most of them were retrospective, had a small population, and were single-arm.…”

Section: Discussionmentioning

confidence: 99%

Survival Benefit of Hepatic Arterial Infusion Chemotherapy over Sorafenib in the Treatment of Locally Progressed Hepatocellular Carcinoma

Iwamoto

Nishizaki

Nagamatsu

et al. 2021

Cancers

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BACKROUND: Not all patients with hepatocellular carcinoma (HCC) benefit from treatment with molecular targeted agents such as sorafenib. We investigated whether New-FP (fine-powder cisplatin and 5-fluorouracil), a hepatic arterial infusion chemotherapy regimen, is more favorable than sorafenib as an initial treatment for locally progressed HCC. METHODS: To avoid selection bias, we corrected the data from different facilities that did or did not perform New-FP therapy. In total, 1709 consecutive patients with HCC initially treated with New-FP or sorafenib; 1624 (New-FP, n = 644; sorafenib n = 980) were assessed. After propensity score matching (PSM), overall survival (OS) and prognostic factors were assessed (n = 344 each). Additionally, the patients were categorized into four groups: cohort-1 [(without macrovascular invasion (MVI) and extrahepatic spread (EHS)], cohort-2 (with MVI), cohort-3 (with EHS), and cohort-4 (with MVI and EHS) to clarify the efficacy of each treatment. RESULTS: New-FP prolonged OS than sorafenib after PSM (New-FP, 12 months; sorafenib, 7.9 months; p < 0.001). Sorafenib treatment, and severe MVI and EHS were poor prognostic factors. In the subgroup analyses, the OS was significantly longer the New-FP group in cohort-2. CONCLUSIONS: Local treatment using New-FP is a potentially superior initial treatment compared with sorafenib as a multidisciplinary treatment in locally progressed HCC without EHS.

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Locoregional Therapy Approaches for Hepatocellular Carcinoma: Recent Advances and Management Strategies

Cited by 94 publications

References 165 publications

Using Hepatocellular Carcinoma Tumor Burden Score to Stratify Prognosis after Liver Transplantation

Using Hepatocellular Carcinoma Tumor Burden Score to Stratify Prognosis after Liver Transplantation

Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma

Survival Benefit of Hepatic Arterial Infusion Chemotherapy over Sorafenib in the Treatment of Locally Progressed Hepatocellular Carcinoma

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