How I Do It: Systemic Therapies for Primary Liver Cancers

Area of Science:

• Oncology
• Radiology
• Medical Imaging

Background:

• Primary liver cancer, encompassing hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), is a major global cause of cancer mortality.
• Systemic therapies, notably immunotherapy, have recently enhanced outcomes for advanced liver cancer and are expanding to earlier stages and combination treatments.

Purpose of the Study:

• To provide an updated overview of systemic therapies for HCC and iCCA.
• To summarize landmark clinical trial findings and discuss imaging-based treatment response assessment for radiologists.

Main Methods:

• Review of current systemic therapies for primary liver cancer.
• Analysis of key clinical trial outcomes.
• Discussion of imaging considerations for treatment response evaluation.

Main Results:

• Systemic therapies, especially immunotherapy, show significant improvements in advanced HCC and iCCA.
• Standardized criteria (RECIST) are used in trials, but daily practice requires broader assessment.
• Radiologists need to evaluate biologic effects like necrosis and vascularity changes, not just tumor size.

Conclusions:

• Radiologists play a crucial role in assessing treatment response to evolving systemic therapies for primary liver cancer.
• A comprehensive imaging approach beyond size is essential for informing treatment decisions and optimizing patient care.
• Multidisciplinary collaboration is key in integrating imaging findings with personalized systemic treatments.