Immune checkpoint inhibitors in hepatocellular carcinoma: emerging challenges in clinical practice

Area of Science:

• Hepatobiliary cancers
• Medical oncology
• Immunotherapy

Background:

• Systemic therapy for advanced hepatocellular carcinoma (HCC) has rapidly evolved.
• Immune checkpoint inhibitors (ICIs) have replaced tyrosine kinase inhibitors as first-line treatment for HCC.
• Significant challenges exist in delivering immunotherapy in clinical practice.

Purpose of the Study:

• To identify knowledge gaps regarding ICI-based therapies in patients with Child-Pugh class B HCC.
• To discuss challenges associated with rare histological subtypes of primary liver cancer.
• To review data on ICI rechallenge and atypical immunotherapy-related progression patterns.

Main Methods:

• Literature review and expert discussion.
• Analysis of current clinical practice challenges.
• Examination of data on specific patient populations and treatment responses.

Main Results:

• Gaps in knowledge exist for ICI use in Child-Pugh B patients.
• Rare HCC subtypes (combined hepatocellular-cholangiocarcinoma, fibrolamellar HCC, sarcomatoid HCC) present unique treatment challenges.
• Atypical progression patterns like hyperprogressive disease and pseudoprogression require further understanding.

Conclusions:

• Further research is needed to optimize ICI therapy for specific HCC patient groups, including those with Child-Pugh B and rare histological subtypes.
• Understanding and managing atypical treatment responses are crucial for effective immunotherapy in advanced HCC.
• ICI rechallenge strategies require more investigation.