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Abstract Details
Hepatocellular Carcinoma Down-Staging for Liver Transplantation in the Era of Systemic Combined Therapy with Anti-VEGF/TKI and Immunotherapy
Hepatology. 2022 Jun 28. doi: 10.1002/hep.32613. Online ahead of print.
1Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN.
2BCLC group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS. CIBEREHD. University of Barcelona., Spain.
3Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, Rochester, MN.
4Division of Radiation Oncology, Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
Abstract
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 while others have attempted downstaging approaches. While 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, novel 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.