Expanding the path to cure - a narrative review on optimizing multimodality sequencing in HCC

Area of Science:

• Hepatobiliary oncology
• Translational cancer research
• Personalized medicine

Background:

• Hepatocellular carcinoma (HCC) management is evolving towards personalized, multimodality approaches.
• Enhanced efficacy of locoregional therapies (LRTs) and systemic treatments expands options for both curative and palliative care.
• New strategies are emerging for bridging to liver transplantation and perioperative treatment.

Purpose of the Study:

• To review current advances in multimodality treatment for hepatocellular carcinoma (HCC).
• To highlight emerging therapies and combinations for various stages of HCC.
• To emphasize the role of multidisciplinary care in optimizing outcomes.

Main Methods:

• Review of recent clinical trials and therapeutic advancements in HCC.
• Analysis of locoregional therapies (LRTs), systemic regimens, and immune checkpoint inhibitors (ICIs).
• Exploration of combination strategies and curative conversion approaches.

Main Results:

• Immune checkpoint inhibitor (ICI)-based regimens show improved pathological response and survival in resectable HCC.
• Combination therapies, including ICI-antiangiogenic regimens with transarterial chemoembolization, improve response rates and progression-free survival.
• Stereotactic body radiotherapy (SBRT) demonstrates efficacy in advanced HCC and as an alternative bridging therapy.

Conclusions:

• Multimodality treatment offers significant promise for expanding curative options in HCC.
• Emerging curative conversion strategies can enable treatment in previously incurable patients.
• A multidisciplinary approach is crucial for selecting patients, tailoring treatments, and managing toxicity for optimal HCC management.