Neoadjuvant and adjuvant systemic therapy in HCC: Current status and the future

Area of Science:

• Hepatocellular Carcinoma (HCC) Management
• Surgical Oncology
• Medical Oncology

Background:

• Surgical resection offers long-term survival for early-stage HCC but recurrence remains a challenge.
• Previous adjuvant therapies, including tyrosine kinase inhibitors, showed limited efficacy.
• Recent advances in systemic therapies, particularly immune checkpoint inhibitors, have revitalized interest in adjuvant and neoadjuvant strategies.

Purpose of the Study:

• To review the evolving role of systemic therapies, including immunotherapy, in the perioperative management of hepatocellular carcinoma.
• To discuss the potential of neoadjuvant immunotherapy and its use as a bridging strategy for liver transplantation.
• To highlight the importance of multidisciplinary care in decision-making for complex HCC cases.

Main Methods:

• Review of recent clinical trial data, including the IMBrave050 trial.
• Analysis of emerging evidence for neoadjuvant immunotherapy in HCC.
• Evaluation of current data on immunotherapy use in the context of liver transplantation.

Main Results:

• Adjuvant atezolizumab plus bevacizumab demonstrated improved recurrence-free survival in high-risk HCC patients post-surgery.
• Early data suggest high response rates for neoadjuvant immunotherapy, though larger trials are needed.
• Immunotherapy is safe short-term for bridging to liver transplantation, but post-transplant use is discouraged due to rejection risks.

Conclusions:

• Adjuvant and neoadjuvant immunotherapies represent promising strategies to improve outcomes in early-stage HCC.
• Systemic therapies may serve as effective bridging options for liver transplantation, requiring further investigation.
• Multidisciplinary collaboration is essential for optimizing treatment decisions in the complex landscape of HCC management.