Application of systemic treatment in conversion therapy options for liver cancer

Bei, Haoyang; Mai, Weiheng; Chen, Weifeng; Li, Mingyi; Yang, Yunxia

doi:10.3389/fonc.2022.966821

Cited by 4 publications

(3 citation statements)

References 57 publications

(81 reference statements)

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“…Previous research has shown that the ceiling effect of ORR is difficult to overcome with single local or single targeted therapy or immunotherapy treatment. 19 Thus, a combination approach is necessary to overcome this limitation. The most frequently employed combination models are systemic-systemic and systemic-local, with the latter delivering a higher success rate in conversion and an increased ORR, by overcoming TKI resistance and immunological tolerance.…”

Section: Selecting the Appropriate Conversion Strategymentioning

confidence: 99%

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Chen,

Chen

et al. 2024

J Clin Transl Hepatol

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The high mortality rate in hepatocellular carcinoma (HCC) is partially due to the fact that a significant number of patients are diagnosed at an intermediate or advanced stage, with surgical treatment options unavailable. Conversion therapy, which involves both locoregional and systemic treatments, has the potential to downstage tumors in selected patients with initially unresectable HCC, thereby making surgical treatment a possibility and potentially increasing long-term survival. To optimize the conversion rate, it is necessary to maximize successful conversions and clearly define the target population for conversion treatment through a collaborative effort. In this review article, we summarize the clinical experience and evidence for conversion therapy in patients with ‘potentially resectable’ HCC from four perspectives: 1) defining the target population for conversion therapy, 2) selecting the appropriate conversion strategy, placing emphasis on the utilization of combination therapy that exhibits a significant objective response rate, 3) determining the timing and urgency of surgical resection, 4) promoting the adoption of a multidisciplinary team model. The authors are optimistic that with the continuous progress in treatment and a deeper understanding of HCC, the success rate of HCC conversion therapy will increase, and the overall survival of HCC patients will be prolonged.

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Section: Selecting the Appropriate Conversion Strategymentioning

confidence: 99%

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Chen,

Chen

et al. 2024

J Clin Transl Hepatol

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“…Unfortunately, the therapeutic options for HCC remain somewhat limited within this complex landscape. Surgical interventions necessitate stringent evaluation of tumor size and metastasis, imposing strict eligibility criteria on patients (Bei et al, 2022). Radiation therapy, while effective, inflicts collateral damage on the patient's body, leading to significant adverse reactions (Gallicchio et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Natural products targeting macroautophagy signaling in hepatocellular carcinoma therapy: Recent evidence and perspectives

Chen,

Tan,

Zhang

et al. 2024

Phytotherapy Research

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Hepatocellular carcinoma (HCC), presently the second leading cause of global cancer‐related mortality, continues to pose significant challenges in the realm of medical oncology, impacting both clinical drug selection and mechanistic research. Recent investigations have unveiled autophagy‐related signaling as a promising avenue for HCC treatment. A growing body of research has highlighted the pivotal role of autophagy‐modulating natural products in inhibiting HCC progression. In this context, we provide a concise overview of the fundamental autophagy mechanism and delineate the involvement of autophagic signaling pathways in HCC development. Additionally, we review pertinent studies demonstrating how natural products regulate autophagy to mitigate HCC. Our findings indicate that natural products exhibit cytotoxic effects through the induction of excessive autophagy, simultaneously impeding HCC cell proliferation by autophagy inhibition, thereby depriving HCC cells of essential energy. These effects have been associated with various signaling pathways, including PI3K/AKT, MAPK, AMPK, Wnt/β‐catenin, Beclin‐1, and ferroautophagy. These results underscore the considerable therapeutic potential of natural products in HCC treatment. However, it is important to note that the present study did not establish definitive thresholds for autophagy induction or inhibition by natural products. Further research in this domain is imperative to gain comprehensive insights into the dual role of autophagy, equipping us with a better understanding of this double‐edged sword in HCC management.

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“…Patients with unresectable HCC could undergo downstaging to reduce the tumor volume and will be eligible for salvage hepatectomy or liver transplantation. In addition to reducing the tumor volume, downstaging also helps in decreasing metastases and portal vein tumor thrombus and increasing residual liver volume through certain treatments [ 3 , 4 ]. The traditional conversion methods include transcatheter arterial chemoembolization (TACE), portal vein embolization (PVE), transarterial radioembolization (TARE), radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), and so on.…”

Section: Introductionmentioning

confidence: 99%

Conversion surgery for advanced hepatocellular carcinoma after combination treatment of lenvatinib and camrelizumab: a case report

Chen

et al. 2023

World J Surg Onc

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Background Hepatocellular carcinoma (HCC) is an aggressive malignancy with high morbidity and mortality. Conversion therapy can improve surgical resection rate and prolong survival time for patients with advanced HCC. We show that combination therapy with lenvatinib and camrelizumab is a novel approach to downstage unresectable HCC. Case presentation A 49-year-old man was diagnosed with massive HCC with hilar lymph node and lung metastases. Since radical resection was not feasible, lenvatinib and camrelizumab were administered as first-line therapy. After 10 cycles of camrelizumab and continuous oral administration of lenvatinib, the tumor exhibited striking shrinkage in volume indicating a partial radiological response, accompanied by a reduction in the alpha-fetoprotein levels, followed by salvage resection. Intriguingly, an improvement in predictive biomarkers, like lactate dehydrogenase (LDH) and neutrophil-to-lymphocyte ratio (NLR), was observed. Notably, the pathological examination found high levels of necrosis in the resected tumor, and flow cytometry analysis indicated a significant increase in the ratio of CD5+ and CD5− B lymphocytes in the peripheral blood. After the treatment, the overall survival period was over 24 months, and no recurrence was observed 17-month post-surgery. Conclusions A combination of lenvatinib and camrelizumab may be a new conversion therapy for initially unresectable HCC to resectable HCC, thus contributing to improve the disease prognosis. In addition, the combination regimen could cause an activated immune response, and LDH, NLR, and CD5+ B-cell levels might be predictors for immunotherapy efficacy.

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Application of systemic treatment in conversion therapy options for liver cancer

Cited by 4 publications

References 57 publications

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Natural products targeting macroautophagy signaling in hepatocellular carcinoma therapy: Recent evidence and perspectives

Conversion surgery for advanced hepatocellular carcinoma after combination treatment of lenvatinib and camrelizumab: a case report

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