Review article: delivering precision oncology in intermediate‐stage liver cancer

Pinato, David J.; Howell, Jessica; Ramaswami, Ramya; Sharma, Rohini

doi:10.1111/apt.14066

Cited by 32 publications

(29 citation statements)

References 72 publications

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“…However, the reported OS after TACE was highly variable, ranging from 11‐45 months . The wide variation of OS after TACE was mainly because of the heterogeneous population of BCLC stage B HCC patients with varying tumour burdens, liver function (Child‐Pugh class A or B), disease aetiology and comorbidities …”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] The wide variation of OS after TACE was mainly because of the heterogeneous population of BCLC stage B HCC patients with varying tumour burdens, liver function (Child-Pugh class A or B), disease aetiology and comorbidities. 9 Owing to the significant degree of disease heterogeneity in BCLC stage B HCC, BCLC stage B subclassifications have been proposed, 10,11 whereas several prognostic models have been developed to predict survival after TACE. [12][13][14][15][16][17][18] Nevertheless, some of the prediction models were developed from HCC patients with various BCLC stages, suggesting an even more heterogeneous population.…”

Section: Introductionmentioning

confidence: 99%

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A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

Lee

Hung

Liu

et al. 2019

Liver International

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Background & Aims Transarterial chemoembolization (TACE) is a standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the outcome varied. This study aimed to develop a model to predict the outcome of TACE in HCC patients. Methods Consecutive 570 treatment‐naïve BCLC stage B HCC patients undergoing TACE as the initial treatment from 2007 to 2016 were retrospectively enrolled. Factors associated with survival were analysed. Patients undergoing TACE from 2007 to 2011 constituted the training cohort (n = 293), while patients undergoing TACE from 2012 to 2016 constituted the validation cohort (n = 277). Homogeneity and corrected Akaike information criterion (AICc) were compared between each prognostic model. Results A total of 1796 TACE sessions were performed for the 570 patients during the median follow‐up period of 18.3 months. By multivariate analysis, beyond up‐to‐11 criteria (hazard ratio [HR] = 1.694, P < .001), alpha‐foetoprotein >200 ng/mL (HR = 1.771, P < .001) and albumin‐bilirubin (ALBI) grade 2 or 3 (HR = 1.817, P < .001) were independent predictors of overall survival (OS) in the training cohort. An ALBI‐TAE model based on the three independent predictors of OS from the training cohort was developed to classify HCC patients into four subgroups. The performance of the ALBI‐TAE model was superior to other prognostic models with lowest AICc values and highest homogeneity in both the training and validation datasets as well as the overall cohort. Conclusions Albumin‐bilirubin grade is an important factor associated with survival in BCLC stage B HCC patients undergoing TACE. ALBI‐TAE model can be applied to select patients who can get most benefit from TACE.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

Lee

Hung

Liu

et al. 2019

Liver International

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“…Careful patient selection for This article is protected by copyright. All rights reserved Accepted Article TACE would be required, with many centers utilizing clinical algorithms to ascertain survival benefit from TACE (6). In the majority of patients, TACE could be performed as a day case where possible, in an attempt to minimize the risk of hospital acquired infection, with patients having bloods conducted by their local practitioner prior to admission.…”

Section: Accepted Articlementioning

confidence: 99%

Management of Hepatocellular Cancer in the time of SARS‐CoV‐2

Sharma

Pinato

2020

Liver International

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Radical therapies with high potenƟal for cure First-line palliaƟve therapies with substanƟal OS benefit Repeat or second-line palliaƟve therapies with proven OS benefit PalliaƟve therapies without substanƟal OS benefit Liver TransplantaƟon Liver ResecƟon Local ablaƟon TACE in BCLC B HCC Sorafenib, LenvaƟnib Repeat TACE beyond 2 sessions Y90 radioembolizaƟon Nivolumab, Pembrolizumab Repeat TACE (up to 2 sessions in responding lesions) Regorafenib, CabozanƟnib, Ramucirumab (AFP>400)

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“…Despite active screening programs, approximately 50%‐60% of HCC cases present with intermediate‐stage disease in which TACE is the recommended first‐line therapy . Wide clinical heterogeneity exists in this patient population who will inevitably progress after TACE with a mOS of 24 months . Migration of this patient group to systemic treatment is possible, but survival outcomes are poor because of the limited efficacy of sorafenib .…”

Section: Classes Of the Forerunner Checkpoint Molecules And Their Inhmentioning

confidence: 99%

Challenges and Opportunities in the Clinical Development of Immune Checkpoint Inhibitors for Hepatocellular Carcinoma

Flynn¹,

Sayed

Sharma

et al. 2019

Hepatology

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After a decade of stagnation in drug development, therapeutic reversal of immune-exhaustion with immune checkpoint inhibitors (ICPIs) has been shown to be effective in advanced hepatocellular carcinoma (HCC). The clinical development of novel ICPIs continues at a rapid pace, with more than 50 clinical trials of immunotherapeutic agents registered as of May 2018 for this indication. The development of ICPI is particularly challenging in patients with HCC, a population with unique features which impact on safety and efficacy of immune-modulating therapies. In this review, we discuss the biological foundations supporting the development of ICPIs across the advancing stages of HCC, focusing on the rational positioning of ICPIs across the various Barcelona-Clinic Liver Cancer (BCLC) stages of the disease. Translational studies should guide adequate prioritization of those therapeutic agents and combination strategies which are most likely to achieve patient benefit based on solid mechanistic and clinical justifications. (Hepatology 2019;69:2258-2270).T he role of immune evasion as a pivotal mechanism in the progression of hepatocellular carcinoma (HCC) has long been recognized, but has for many decades remained an "undruggable" domain attributed to the lack of effective therapies capable of reversing cancer-related immunosuppression. (1) Clinical trials of immune checkpoint inhibitors (ICPIs) have ascribed HCC to the expanding list of tumors characterized by intrinsic sensitivity to immunotherapy. In particular, these agents have been proven effective in advanced melanoma, renal cell carcinoma, and non-small-cell lung cancer (NSCLC), with an increasing number of studies demonstrating response rates of up to 25% across hematological and solid malignancies. However, despite the unprecedented efficacy of ICPIs, patients with HCC represent a population with distinct features. The concomitant presence of cirrhosis in >80% of patients is unique and deserves to be considered for its potential safety impact on the delivery of immunotherapy.In terms of efficacy, the presence of a predominantly immunosuppressive microenvironment within

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Review article: delivering precision oncology in intermediate‐stage liver cancer

Cited by 32 publications

References 72 publications

A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

Management of Hepatocellular Cancer in the time of SARS‐CoV‐2

Challenges and Opportunities in the Clinical Development of Immune Checkpoint Inhibitors for Hepatocellular Carcinoma

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