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Abstract Details
Immunotherapy-Based Treatments of Hepatocellular Carcinoma: AJR Expert Panel Narrative Review
AJR Am J Roentgenol. 2022 May 4. doi: 10.2214/AJR.22.27633.Online ahead of print.
1Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy.
2Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy.
3Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY USA.
4Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA.
5Medical Oncology. Instituto do Cancer do Estado de São Paulo. University of São Paulo, Brazil.
6Université de Paris, Centre of Research on Inflammation, INSERM U1149, Paris, & Department of Radiology, Beaujon Hospital, APHP.Nord, Clichy, France.
7BCLC group - Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Catalonia-Spain.
Abstract
The advent of immunotherapy for patients with hepatocellular carcinoma (HCC) has changed the treatment landscape and conferred survival benefit for patients with advanced HCC who typically have a very poor prognosis. The most pronounced improvements in response, as documented by standardized response criteria based on CT or MRI, have been achieved when immunotherapy is combined with other systemic or locoregional therapies. Immune checkpoint inhibitor treatments result in unique patterns on CT and MRI that challenge the application of conventional response criteria such as RECIST, modified RECIST, and European Association for the Study of the Liver criteria. Thus, newer criteria have been developed to gauge therapy response or disease progression for patients on immunotherapy, including immune-related RECIST (iRECIST) and immune-modified RECIST (imRECIST), though these remain unvalidated. In this review, we describe the current landscape of immunotherapeutic agents used for HCC, summarize results of published studies, review pathobiological mechanisms that provide a rationale for the use of these agents, and report on the status of response assessment for immunotherapy, either alone or in combination with other treatment options. Finally, consensus statements are provided to inform radiologists on essential considerations in the era of a rapidly changing treatment paradigm for patients with HCC.