S2780 Nivolumab as a Bridge to Liver Transplantation in Advanced Hepatocellular Carcinoma

Peterson, Julie; Stanek, Steven; Kalman, Richard; Váradi, Gábor; Natarajan, B.

doi:10.14309/01.ajg.0000784652.95008.8e

Cited by 9 publications

(5 citation statements)

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“…We have collated data from all reported patients who received checkpoint inhibitors just before liver transplantation for HCC (Table 3). These include 4 case series [79][80][81][82] and various single case reports [83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99]. Altogether, rejection occurred in 8 out of 41 patients, in which there were 2 deaths[89,95] and 1 requiring re-transplant [81,83].…”

Section: Immune Checkpoint Inhibitorsmentioning

confidence: 99%

“…These include four case-series [79][80][81][82] and various single case reports. [83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99] Altogether, rejection occurred in 8 out of 41 patients, in which there were 2 deaths 89,95 and 1 required retransplant. 81,83 It is proposed that the time between the last immune checkpoint inhibitor application and a liver transplant may influence the likelihood of rejection.…”

Section: Immune Checkpoint Inhibitorsmentioning

confidence: 99%

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Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liu,

Sethi,

et al. 2024

Semin Liver Dis

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Liver transplantation (LT) is a highly effective treatment for carefully selected patients with hepatocellular carcinoma (HCC). In this review, we explored the development of LT selection criteria and organ allocation policies, comparing original data to underscore their historical progression into the intricate task of quantitatively estimating pre- and post-LT survivals. We emphasized the role of biomarkers such as serum AFP, DCP, circulating tumor cells, and circulating tumor DNA in predicting patient outcomes. Additionally, we examined the transplant-associated survival benefits and the difficulties in accurately calculating these benefits. We also reviewed recent advancements in targeted therapy and checkpoint inhibitors for advanced, inoperable HCC and projected their integration into liver transplantation for HCC. We further discussed the growing use of living donor liver transplants in the United States and compared its outcomes with those of deceased donor liver transplants. Furthermore, we examined the progress in machine perfusion techniques, which have shown potential in improving patient outcomes and enlarging the donor pool. These advancements present opportunities to enhance LT patient survivals, refine selection criteria, establish new priority metrics, develop innovative bridging and downstaging strategies, and formulate redesigned LT strategies for HCC treatments.

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Section: Immune Checkpoint Inhibitorsmentioning

confidence: 99%

Section: Immune Checkpoint Inhibitorsmentioning

confidence: 99%

Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liu,

Sethi,

et al. 2024

Semin Liver Dis

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“…Despite the high response rate with ICIs, LRT was applied to stabilize lesions or to consolidate a response in five patients [89][90][91][92]. Patients' outcomes varied considerably in each study.…”

Section: Immunotherapy In Lt: Down-staging and Bridgingmentioning

confidence: 99%

“…Patients' outcomes varied considerably in each study. A successful graft, defined as the absence of acute rejection, was performed in 74% (32/43) of patients [74,[91][92][93][94][95][96][97][98][99]. Xenograft pathology revealed almost complete (>90%) tumor necrosis in seven patients [98,99].…”

Section: Immunotherapy In Lt: Down-staging and Bridgingmentioning

confidence: 99%

Evolving Landscape in Liver Transplantation for Hepatocellular Carcinoma: From Stage Migration to Immunotherapy Revolution

Cesario

Genovesi

Salani

et al. 2023

Life

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Liver transplantation (LT) represents the primary curative option for HCC. Despite the extension of transplantation criteria and conversion with down-staging loco-regional treatments, transplantation is not always possible. The introduction of new standards of care in advanced HCC including a combination of immune checkpoint inhibitor-based therapies led to an improvement in response rates and could represent a promising strategy for down-staging the tumor burden. In this review, we identify reports and series, comprising a total of 43 patients who received immune checkpoint inhibitors as bridging or down-staging therapies prior to LT. Overall, treated patients registered an objective response rate of 21%, and 14 patients were reduced within the Milan criteria. Graft rejection was reported in seven patients, resulting in the death of four patients; in the remaining cases, LT was performed safely after immunotherapy. Further investigations are required to define the duration of immune checkpoint inhibitors, their minimum washout period and the LT long-term safety of this strategy. Some randomized clinical trials including immunotherapy combinations, loco-regional treatment and/or tyrosine kinase inhibitors are ongoing and will likely determine the appropriateness of immune checkpoint inhibitors’ administration before LT.

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“…All other patients who experienced rejection had an interval time of less than 3.5 half-lives between their last dose of immunotherapy and transplant. Peterson et al reported a patient with HCV cirrhosis who was successfully transplanted 304 days after treatment with nivolumab [ 30 ]. Another patient with HCV cirrhosis described by Schnickel et al was transplanted 6 months following treatment with nivolumab and had no evidence of rejection [ 32 ].…”

Section: Pre-transplant Use Of Immunotherapymentioning

confidence: 99%

Immunotherapy Use Prior to Liver Transplant in Patients with Hepatocellular Carcinoma

et al. 2022

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Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related mortality worldwide, and its incidence has increased rapidly in the United States over the past two decades. Liver transplant is considered curative, but is not always possible, and pre-transplant immunotherapy is of great interest as a modality for downstaging the tumor burden. We present a review of the literature on pre-liver transplant immunotherapy use in patients with HCC. Our literature search queried publications in Ovid MEDLINE, Ovid Embase, and Web of Science, and ultimately identified 24 original research publications to be included for analysis. We found that the role of PD-1 and PD-L1 in risk stratification for rejection is of special interest to researchers, and ongoing randomized clinical trials PLENTY and Dulect 2020-1 will provide insight into the role of PD-1 and PD-L1 in liver transplant management in the future. This literature search and the resulting review represents the most thorough collection, analysis, and presentation of the literature on the subject to date.

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S2780 Nivolumab as a Bridge to Liver Transplantation in Advanced Hepatocellular Carcinoma

Cited by 9 publications

References 0 publications

Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Evolving Landscape in Liver Transplantation for Hepatocellular Carcinoma: From Stage Migration to Immunotherapy Revolution

Immunotherapy Use Prior to Liver Transplant in Patients with Hepatocellular Carcinoma

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