Chinese expert consensus on conversion therapy for hepatocellular carcinoma (2021 edition)

Abstract

Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma (HCC) have resulted in improved response rates. This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection, a 'conversion therapy' strategy. However, conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed. Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review: Many research centers in China have accumulated significant experience implementing HCC conversion therapy. Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC; however, there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields. In order to summarize and learn from past experience and review current challenges, the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma (2021 Edition) was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice. Sixteen consensus statements on the implementation of conversion therapy for HCC were developed. The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.

Conversion therapy with an immune checkpoint inhibitor and an antiangiogenic drug for advanced hepatocellular carcinoma: A review

“…In recent years, ICIs and AADs have y encouraging outcomes in the treatment of various solid tumors. New drugs including multikinase inhibitors (such as lenvatinib; target of TKIs are summarized in Table 4) and programmed cell death protein 1 (PD-1 as well as programmed cell death ligand 1 and its inhibitors such as pembrolizumab and atezolizumab; combinations of an ICI and an AAD are summarized in Table 5 (11,(48)(49)(50)) have proven effective in the treatment of advanced HCC and have been successively recommended by domestic and international HCC guidelines (16,46,51,52). The ORR of an ICI or AAD alone is only 9.2-24.1% (49,53).…”

“…For patients who fail to respond to conversion therapy, second-line approaches need to be taken in accordance with the pattern of tumor progression. Concomitant local therapy or a next-line regimen might be necessary for non-responding or progressive tumors (11).…”

“…Based on discussions among and opinions of domestic experts, preliminary recommendations on post-operative regimens have been formulated. Use of the original conversion therapy regimen for adjuvant therapy after surgery is reasonable, and a consensus recommended that postoperative adjuvant therapy last over six months (11,18,19). As a key component in antitumor immunity, memory T-cell recruitment plays a crucial role in longterm maintenance of the antitumor cytotoxic effects of therapy during postoperative immunosurveillance.…”

“…Hepatocellular carcinoma (HCC) has been the fifth most common malignancy worldwide, with over 500,000 new cases every year, and it represents the second leading cause of tumor-related mortality globally (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). There is a considerable geographical imbalance in the incidence of HCC.…”

It’s time to propose a uniform criteria for determining “clinical complete response” in hepatocellular carcinoma

“…If different systemic regimes were combined with loco-regional therapies, the chance of achieving CR was even higher. These findings promoted the practice of conversion surgery in HCC (2,3). After tumors were converted and resected, a subgroup of HCC reached its pathological CR (pCR).…”