Immunotherapy-Based Conversion to Curative-Intent Treatment in Hepatocellular Carcinoma: A Multidisciplinary...

Area of Science:

• Hepatobiliary Oncology
• Immunotherapy Research
• Translational Cancer Medicine

Background:

• Immune checkpoint inhibitors (ICIs) are now standard for advanced hepatocellular carcinoma (HCC).
• Improved responses mean some patients may become eligible for curative treatments post-immunotherapy.
• Current decision-making lacks a unified framework for post-immunotherapy curative-intent candidacy.

Purpose of the Study:

• To propose a multidisciplinary framework for selecting HCC patients for curative-intent treatment after ICI therapy.
• To clarify terminology related to treatment conversion and downstaging in HCC.
• To integrate technical, oncologic, and liver reserve suitability for decision-making.

Main Methods:

• Narrative review of existing literature and clinical evidence.
• Development of a conceptual framework based on three suitability domains.
• Analysis of conversion-relevant evidence across different HCC clinical scenarios.

Main Results:

• A proposed framework integrating technical, oncologic, and physiologic suitability for curative-intent transition.
• Discussion of biomarkers, imaging, tumor markers, liver function, and toxicity as inputs.
• Highlighting regional differences in terminology and practice (resection vs. transplant-anchored).

Conclusions:

• The proposed framework aims to structure multidisciplinary discussions for HCC conversion therapy.
• Further validation through harmonized terminology, registries, and specific endpoints is needed.
• Lessons from other cancers like pancreatic, biliary, and colorectal liver metastases are considered.