Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma

Abstract

Patients with advanced hepatocellular carcinoma (HCC) have historically had few options and faced extremely poor prognoses if their disease progressed after standard-of-care tyrosine kinase inhibitors (TKIs). Recently, the standard of care for HCC has been transformed as a combination of the immune checkpoint inhibitor (ICI) atezolizumab plus the anti-vascular endothelial growth factor (VEGF) antibody bevacizumab was shown to offer improved overall survival in the first-line setting. Immunotherapy has demonstrated safety and efficacy in later lines of therapy as well, and ongoing trials are investigating novel combinations of ICIs and TKIs, in addition to interventions earlier in the course of disease or in combination with liver-directed therapies. Because HCC usually develops against a background of cirrhosis, immunotherapy for liver tumors is complex and oncologists need to account for both immunological and hepatological considerations when developing a treatment plan for their patients. To provide guidance to the oncology community on important concerns for the immunotherapeutic care of HCC, the Society for Immunotherapy of Cancer (SITC) convened a multidisciplinary panel of experts to develop a clinical practice guideline (CPG). The expert panel drew on the published literature as well as their clinical experience to develop recommendations for healthcare professionals on these important aspects of immunotherapeutic treatment for HCC, including diagnosis and staging, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with HCC.

Drug Treatment for Advanced Hepatocellular Carcinoma: First-Line and Beyond

“…In summary, for Child A cirrhosis patients with satisfactory performance status, atezolizumab–bevacizumab is now recommended as the first-line therapy. This is consistent with the ASCO 2020 guideline [ 14 ], the Society for Immunotherapy of Cancer 2021 guideline [ 26 ], and the recommendation from the EASL [ 27 ].…”

Interleukin-6 Is a Circulating Prognostic Biomarker for Hepatocellular Carcinoma Patients Treated with Combined Immunotherapy

“…Furthermore, in a recently published update analysis with a median follow-up of 15.6 months, Atezo/Bev therapy showed a 5.8 month longer median OS than sorafenib [ 6 ] and a safety profile consistent with the primary analysis [ 5 ]. Objective response occurred in 30% of patients treated with Atezo/Bev therapy, and 74% of patients obtained disease control, so this therapy now serves as a potent front-line chemotherapy [ 7 ]. On the other hand, 19% of treated patients were reported to be non-responders [ 5 ].…”

Efficacy of Drug-Eluting Beads Transarterial Chemoembolization Plus Camrelizumab Compared With Conventional Transarterial Chemoembolization Plus Camrelizumab for Unresectable Hepatocellular Carcinoma

“… 22 , 23 Despite the superior design concept of D-TACE, a previous study demonstrated that D-TACE enhanced tumor response but did not improve survival in patients with BCLC stage A and B. 24 Since the mode of drug-delivery between D-TACE and C-TACE is different, there is need to explore the difference in efficacy between a combination of D-TACE and ICIs, (the drugs recommended for advanced HCC 25 ), and a combination of C-TACE and ICIs.…”