Downstaging of advanced hepatocellular carcinoma followed by liver transplantation using immune checkpoint inhibitors: Where do we stand?
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View abstract on PubMed
Summary
This summary is machine-generated.Immune checkpoint inhibitors show promise for downstaging advanced hepatocellular carcinoma (HCC) before liver transplantation (LT). Combination immunotherapy offers hope for patients with multifocal HCC or portal vein tumor thrombosis, though further studies are needed.
Area Of Science
- Hepatology
- Oncology
- Immunotherapy
Background
- Liver transplantation (LT) for hepatocellular carcinoma (HCC) is restricted by tumor burden and invasion.
- Advanced HCC patients often exceed current transplant criteria.
- Immune checkpoint inhibitors (ICI) offer new therapeutic avenues.
Purpose Of The Study
- To review the efficacy of ICI in downstaging advanced HCC for LT.
- To assess outcomes and safety of ICI therapy prior to LT.
Main Methods
- Comprehensive literature review using PubMed, Google Scholar, and CrossRef.
- Keywords included 'liver transplant', 'HCC', 'immune checkpoint inhibitors', 'atezolizumab', 'nivolumab'.
Main Results
- Case reports show successful HCC downstaging with atezolizumab/bevacizumab combination prior to LT.
- Early outcomes are comparable to existing transplant criteria.
- Perioperative ICI adverse effects necessitate careful management, with a suggested 1.5-month interval before LT.
Conclusions
- Combination immunotherapy shows encouraging results for downstaging advanced HCC, including multifocal disease and portal vein tumor thrombosis.
- Further prospective studies are required to optimize ICI dosage, duration, and timing for LT.
- Long-term outcomes regarding rejection, infection, recurrence, and survival need evaluation.
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