Neoadjuvant and adjuvant therapy for operable hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Oncology
• Clinical Trials

Background:

• Operable hepatocellular carcinoma (HCC) presents a significant challenge, with surgery being the primary curative treatment.
• Neoadjuvant (preoperative) and adjuvant (postoperative) therapies are explored to improve outcomes, including relapse rates and survival.
• The efficacy and safety of these multimodal approaches require rigorous evaluation.

Purpose of the Study:

• To systematically evaluate the efficacy and adverse effects of neoadjuvant and adjuvant therapies for operable hepatocellular carcinoma.
• To compare these therapies against surgery alone or surgery with placebo/supportive care.
• To determine their impact on relapse and survival rates in HCC patients.

Main Methods:

• A systematic review of randomized and quasi-randomized clinical trials was conducted.
• Searches included electronic databases and conference proceedings.
• Eight trials involving 548 patients were analyzed, focusing on survival and disease-free survival data.

Main Results:

• Seven of eight trials found no survival benefit from adjuvant therapy for operable HCC.
• One trial reported a statistically significant difference in survival and disease-free survival, but with overall poor results.
• High toxicity was observed in some treatment arms, with one regimen causing 12 of 38 patients to discontinue treatment.

Conclusions:

• Current evidence does not support the efficacy of reviewed neoadjuvant and adjuvant therapy protocols for operable HCC.
• Further large-scale, well-designed clinical trials are essential to identify effective treatment strategies.
• Future research should focus on developing and validating therapies that offer a realistic survival advantage.