Bridge Therapy before Liver Transplant for Advanced Hepatocellular Carcinoma

Area of Science:

• Hepatology
• Oncology
• Transplant Surgery

Background:

• Hepatocellular carcinoma (HCC) is the most common primary liver tumor.
• Orthotopic liver transplant is a leading treatment, but transplant waiting lists pose a challenge.
• Bridge therapies aim to manage advanced HCC while patients await transplant.

Purpose of the Study:

• To evaluate the efficacy of bridge therapies in advanced HCC.
• To determine if these therapies improve overall survival.
• To assess the impact on reducing transplant de-listing rates.

Main Methods:

• Systematic review of 185 English-language articles on adult patients.
• Exclusion of articles with incomplete data or irrelevant conclusions.
• Analysis of treatment outcomes for various bridge therapy combinations.

Main Results:

• Sorafenib offers limited survival benefit in advanced HCC.
• Transarterial chemoembolization (TACE) plus sorafenib may delay progression, but survival benefit is uncertain.
• TACE plus radiation therapy, and TACE + radiotherapy + sorafenib show encouraging survival and response rates, with one study showing 24 vs. 17 months survival.

Conclusions:

• Combination therapies, particularly those involving TACE and radiation, demonstrate significant potential as bridge-to-transplant strategies for advanced HCC.
• Immunotherapy presents new avenues for treatment.
• Combined modality treatments may become the standard of care for bridging HCC patients to liver transplantation.