Neoadjuvant Stereotactic Body Radiotherapy plus Immune Therapy Favorably Remodels the Hepatocellular Carcinoma Tumor...

Area of Science:

• Hepatobiliary Oncology
• Radiation Oncology
• Immunotherapy

Background:

• Advanced hepatocellular carcinoma (HCC) treatment has improved with immunotherapy, but its use in earlier stages needs definition.
• Optimal sequencing of therapies for resectable HCC remains an area of active research.

Purpose of the Study:

• To evaluate the safety and efficacy of neoadjuvant stereotactic body radiation therapy (SBRT) followed by atezolizumab and bevacizumab in patients with initially resectable HCC.
• To investigate the impact of this neoadjuvant regimen on the tumor immune microenvironment.

Main Methods:

• A single-arm pilot study enrolled 8 patients with resectable HCC.
• Patients received neoadjuvant SBRT, two cycles of atezolizumab plus bevacizumab, and then surgical resection.
• Safety was assessed by grade 3-4 treatment-related adverse events (trAEs), and tumor immune microenvironment changes were analyzed using spatial transcriptomics.

Main Results:

• The regimen was safe, with only one patient experiencing a grade 3 trAE.
• Seven of eight patients underwent successful R0 resection.
• Post-treatment tumors showed increased anti-cancer immune infiltration, correlating with radiographic response.

Conclusions:

• Neoadjuvant SBRT and immunotherapy is a safe strategy for resectable HCC.
• This approach enhances anti-cancer immunity and provides a rationale for further clinical trials.