A Paradigm Change in the Treatment Strategy for Hepatocellular Carcinoma

Kudo, Masatoshi

doi:10.1159/000507934

Cited by 27 publications

(40 citation statements)

References 59 publications

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“…Inhibition of VEGF or of VEGFR-2 reprograms the microenvironment from immunosuppressive to immunostimulatory [125,126]. Data in CCA are not yet clear, however combination therapy with Pembrolizumab (anti-PD-1L) and Bevacizumab (anti-VEGF) showed an overall response rate of 36% in patients with advanced hepatocellular carcinoma [127].…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

New insights on the role of vascular endothelial growth factor in biliary pathophysiology

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

New insights on the role of vascular endothelial growth factor in biliary pathophysiology

et al. 2021

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“…An inappropriately high number of TACE sessions delays the switch to systemic therapy and may, in some cases, completely hinder the treatment switch due to the deterioration of liver function. [98][99][100][101][102] Both situations may be associated with impaired survival. High tumor burden, multifocality, impaired liver function, early recurrence, incomplete necrosis, massive progression under TACE, and the occurrence of extrahepatic spread and/or vascular invasion should trigger the cessation of TACE treatment and re-evaluation by an interdisciplinary tumor board.…”

Section: Patients No Longer Benefiting From Tacementioning

confidence: 99%

Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide

Müller¹,

Stoehr²,

Mähringer‐Kunz³

et al. 2021

JHC

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Treatment of hepatocellular carcinoma (HCC) depends on the stage of disease. In the Western Hemisphere, the Barcelona Clinic Liver Cancer classification (BCLC) is the preferred staging system. Approximately one-third of patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. However, the intermediate-stage comprises a heterogeneous subgroup of patients with considerable differences in tumor burden and liver function. In addition, differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Due to these differences, not all patients benefit equally from TACE. Several tools and scoring systems have been devised to provide decision-making support. All of these have shown promising initial results but failed external evaluation and have not been translated to the clinic. Nevertheless, criteria for objectifying treatment decisions in daily clinical practice are needed in all stages of disease. Therefore, this review provides a concise practical step-by-step guide on current strategies for patient selection and decisionmaking, with a focus on TACE, to critically evaluate the existing decision-support tools and provide a summary of the latest updates in the field.

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“…We present a draft of the treatment proposal for HAIC for advanced HCC in Figure 1. The combination of atezolizumab and bevacizumab will be shifted to the first-line therapy in patients with Child-Pugh A HCC, regardless of EHM, and currently used MTAs will be shifted to later lines of therapy [10]. HAIC may be an optional treatment in patients with Child-Pugh A HCC and vascular invasion, especially Vp3 or Vp4, without EHM [11,35].…”

Section: Clinical Benefits and Disadvantages Of Haicmentioning

confidence: 99%

“…This combination therapy was approved for unresectable HCC in clinical practice in the United States (US) and Japan in May 2020 and September 2020, respectively. Therefore, combination therapy is likely considered the first-line therapy for advanced HCC, and current first-line MTAs (sorafenib and lenvatinib) and second-line MTAs (regorafenib, ramucirumab, and cabozantinib) are likely to be shifted to second-and third-line therapies, respectively [10]. However, as these above-mentioned drugs have been recommended to HCC patients with preserved liver, those with deteriorated liver function are generally not candidates for such drugs.…”

Section: Introductionmentioning

confidence: 99%

Clinical Benefits of Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma

et al. 2021

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Recent success of systemic therapeutic agents, including combination immunotherapy, could promote a change in the treatment strategy in patients with advanced hepatocellular carcinoma (HCC). Although hepatic arterial infusion chemotherapy (HAIC) is a treatment option for advanced HCC in Japan, it is not recommended by other guidelines. We discuss the clinical benefits of HAIC compared to sorafenib. The clinical benefits of HAIC are as follows: 1) even a patient with Child–Pugh B HCC (7 or 8 points) is a candidate for HAIC; 2) Child–Pugh scores barely decline with the use of HAIC compared with sorafenib; 3) HAIC is highly effective in patients with vascular invasion compared with sorafenib; and 4) survival in patients receiving HAIC may not be associated with skeletal muscle volume. In contrast, the disadvantages are problems related with the reservoir system. HAIC has clinical benefits in a subpopulation of patients without extrahepatic metastasis with Child–Pugh A HCC and vascular invasion (especially primary branch invasion or main portal vein invasion) or with Child–Pugh B HCC.

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A Paradigm Change in the Treatment Strategy for Hepatocellular Carcinoma

Cited by 27 publications

References 59 publications

New insights on the role of vascular endothelial growth factor in biliary pathophysiology

New insights on the role of vascular endothelial growth factor in biliary pathophysiology

Current Strategies to Identify Patients That Will Benefit from TACE Treatment and Future Directions a Practical Step-by-Step Guide

Clinical Benefits of Hepatic Arterial Infusion Chemotherapy for Advanced Hepatocellular Carcinoma

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