Journal
JOURNAL OF HEPATOCELLULAR CARCINOMA
Volume 10, Issue -, Pages 181-191Publisher
DOVE MEDICAL PRESS LTD
DOI: 10.2147/JHC.S347944
Keywords
hepatocellular carcinoma; immune oncology; checkpoint inhibitor; neoadjuvant
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Hepatocellular carcinoma (HCC) necessitates a multidisciplinary evaluation for personalized treatment. Liver resection and transplantation are the main curative treatment options, but disease recurrence remains a burden. Immune checkpoint inhibitors (ICI) have shown promising results in palliative care. However, neoadjuvant ICI therapy is not recommended due to lack of evidence from large Phase III trials. The risk of allograft rejection is a major concern in the context of liver transplantation.
Hepatocellular carcinoma (HCC) is a malignancy that requires multidisciplinary evaluation to develop individualized and tailored treatment concepts. While liver resection and transplantation represent the mainstay of curative treatment in patients with early-stage HCC, disease recurrence remains an important burden. Immune checkpoint inhibitors (ICI) have become standard of care in the palliative setting, achieving promising response rates with overall good tolerability. Accordingly, ICIs are being evaluated in (neo)adjuvant concepts in order to improve survival. Nevertheless, neoadjuvant therapies are not recommended by current guidelines as they have not been proven to improve the outcome in large Phase III trials yet. Especially in the context of liver transplantation (LT), perioperative ICI usage is in need of a particularly critical risk-benefit assessment, as the immunotherapy may significantly increase the risk of rejection. In this review, we summarize available data on ICI-based perioperative treatment strategies in HCC. We discuss current drawbacks and challenges of this treatment concept and specifically highlight the risk of allograft rejection when ICI are given in patients (subsequently) considered for liver transplantation.
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