Breakthroughs in Hepatocellular Carcinoma Therapies

Several breakthroughs in hepatocellular carcinoma (HCC) therapy across tumor stages provide hope to improve its dismal prognosis. Although surgical and local ablative therapies have few significant changes in technique, an improved understanding of tumor biology has facilitated increase numbers of patients who are now eligible to un-dergo curative-intent procedures. Most notably, acceptable post-transplant outcomes can be achieved in well selected patients whose tumors are downstaged into Milan Criteria. Adjuvant therapy in patients at high risk of recurrence also significantly improves recurrence-free survival after resection or ablation. For patients with liver-localized disease who are not eligible for curative-intent procedures, transarterial chemoembolization (TACE) was historically the treatment modality of choice, regardless of tumor burden; however, there is now increased recognition of patients who are TACE unsuitable and may be better treated with systemic therapy. The greatest evolution in HCC treatment options has occurred with systemic therapy, where several new agents are now available in the first -and second-line setting, including immune checkpoint in-hibitor combinations. Objective responses are observed in approximately 30% of patients and median survival is approaching 2 years. The availability of immune check-point inhibitors has renewed interest in combination therapies for earlier tumor stages, with several phase III trials ongoing. Considering increasing complexities of HCC care, requiring decisions between therapies delivered by different providers, multidisciplinary care is critical and is associated with improved clinical outcomes. In this review, we detail major breakthroughs in HCC therapy, how these breakthroughs can be applied in clinical practice, and remaining areas in need of further research.

Automated summary

Breakthroughs in HCC therapy, including surgical and local ablative therapies, have expanded the number of eligible patients for curative-intent procedures. Transarterial chemoembolization (TACE) remains the treatment of choice for liver-localized disease, but there is increasing recognition of patients who may benefit from systemic therapy. Systemic therapy, especially immune checkpoint inhibitor combinations, has shown promising results with objective responses in approximately 30% of patients and improved survival. Multidisciplinary care is critical for complex decision-making and improved clinical outcomes in HCC treatment. Further research is needed to explore combination therapies and identify remaining areas of need.