The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Adjuvant and neoadjuvant therapies for hepatocellular carcinoma
Hepatology. 2023 Dec 18. doi: 10.1097/HEP.0000000000000726. Online ahead of print.
1Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, Canada.
2Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada.
3Hannover Medical School, Hannover, Germany.
4Institute of Medical Science, University of Toronto, Toronto, Ontario.
5Research Department of Oncology, UCL Cancer Institute, University College London, London, UK.
6Royal Free Hospital, London, UK.
7Abdominal Transplant & HPB Surgical Oncology, University Health Network, University of Toronto, Canada.
8Trinity St. James's Cancer Institute, Dublin, Ireland.
Abstract
Immune-oncology based regimens have shown efficacy in advanced hepatocellular carcinoma and have been implemented as standard of care as first line therapy. Their efficacy, including high response rates, and safety justifies their evaluation in earlier disease stages. Following negative results for adjuvant sorafenib in the global STORM trial in 2015, four global phase 3 trials, featuring different immune checkpoint inhibitor combinations, entered in parallel the race in the adjuvant setting. The IMbrave050 trial, comparing adjuvant atezolizumab in combination with bevacizumab to active surveillance following curative-intent resection or ablation, was the first to report, fast-tracking the results of the first interim analysis and demonstrating an improvement in recurrence free survival. The trial has provoked a discussion on the horizon of expectations from adjuvant treatment and the clinical relevance of efficacy endpoints. Moreover, major pathological responses reported from early phase 2 data in the neoadjuvant setting provide a strong rational for the evaluation of these concepts in phase 3 trials. In this review, we summarize current evidence and outline future directions for systemic therapies in early-stage hepatocellular carcinoma.