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Published on: September 30, 2021
Consensus recommendations and review by an International Expert Panel on Interventions in Hepatocellular Carcinoma
Joong-Won Park1, Deepak Amarapurkar, Yee Chao
1Centre for Liver Cancer, National Cancer Center Hospital, Seoul, Korea.
Insights
Hepatocellular carcinoma (HCC) is a challenge in intermediate stages. Combining transarterial chemoembolization (TACE) with targeted systemic therapies may improve outcomes for unresectable HCC patients.
Area of Science:
- Hepatology and Oncology
- Clinical Trial Design
- Cancer Therapeutics
Background:
- Hepatocellular carcinoma (HCC) presents a significant disease burden in East Asia.
- Intermediate-stage HCC (BCLC system) is heterogeneous, posing treatment challenges with standard therapies like transarterial chemoembolization (TACE).
- Current outcomes for intermediate HCC with repeated TACE are often unsatisfactory due to tumor progression or metastasis.
Framework:
- An Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) convened to establish consensus on TACE practices.
- The panel reviewed Asian clinical practices, safety, and efficacy data for TACE alone and combined with targeted systemic therapies.
- Recommendations focus on optimizing therapeutic options for unresectable intermediate-stage HCC.
Implementation:
- Expert consensus suggests exploring TACE combined with systemic targeted agents to enhance patient outcomes.
- Review of current clinical practice and available safety/efficacy data for TACE strategies.
- Focus on evidence-based recommendations for unresectable intermediate HCC management.
Implications:
- Combination therapy of TACE with targeted agents shows promise for improving patient survival in intermediate HCC.
- Further evidence is anticipated from ongoing pivotal Phase II and III Randomized Controlled Trials (RCTs).
- The findings aim to guide clinical practice and improve long-term survival for a challenging HCC patient group.
Abstract:
Hepatocellular carcinoma (HCC) presents with a high burden of disease in East Asian countries. Intermediate-stage HCC as defined by the Barcelona Clinic Liver Cancer (BCLC) staging system poses a clinical challenge as it includes a heterogeneous population of patients that can vary widely in terms of tumour burden, liver function and disease aetiology. Intermediate HCC patients often have unsatisfactory clinical outcomes with repeated transarterial chemoembolization (TACE, due to non-response of the target tumour or the development of further metastasis indicating progressive disease. In September 2011, an Expert Panel Opinion on Interventions in Hepatocellular Carcinoma (EPOIHCC) was convened in HK in an attempt to provide a consensus on the practice of TACE. To that end, current clinical practice throughout Asia was reviewed in detail including safety and efficacy data on TACE alone as well as in combination with targeted systemic therapies. This review summarises the evidence discussed at the meeting and provides expert recommendation regarding the available therapeutic options for unresectable intermediate stage HCC. A key consensus of the Expert Panel was that in order to improve patient outcomes and long-term survival, the possibility of using TACE in combination with targeted agents given systemically should be explored. While the currently available clinical data is promising, the expected completion of several pivotal phase II and III RCTs will provide further evidence in support of the rationale for combination therapy regimens.
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