[Immuno-oncology : No longer a need for interventional radiology?]

Hepatocellular carcinoma (HCC) is associated with a high mortality rate.

For many years, sorafenib was the only, and frequently poorly tolerated systemic treatment option, which lead to the unreflected recurrent use of locoregional treatment modalities, such as transarterial chemoembolization (TACE).

Based on recent positive phase III trial results, we now have three systemic therapeutic options available in the first and second line of treatment, respectively. This development enables us to design sequential treatments concepts for patients with advanced HCC.

Beyond the assessment of tumor burden, the liver function of HCC patients needs to be closely monitored under therapy.

High response rates, including complete remissions have been documented for immuno-oncology-based combination regimens in HCC patients. Already today, a median overall survival (mOS) above 20 months can been achieved through the sequential application of systemic therapies in phase II studies in patients with advanced HCC and preserved liver function.

Local therapies will remain an integral component of HCC therapy. However, recent advancements will shift the focus towards systemic treatment concepts.

The rigorous implementation of validated scoring systems can contribute towards an improved selection of patients that are suited to locoregional therapies. Longitudinal monitoring of liver function is fundamental to ensure that the optimal point in time for a switch towards systemic therapies is not missed.