Combining systemic and local therapies for hepatocellular carcinoma

Immunotherapy for hepatocellular carcinoma has demonstrated encouraging efficacy, with the combination of atezolizumab and bevacizumab in the IMbrave150 trial setting a new benchmark for first-line treatment of unresectable or metastatic disease. 1 Finn RS Qin S Ikeda M et al. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020; 382: 1894-1905 Crossref PubMed Scopus (1455) Google Scholar The positive results of this trial and other immunotherapy trials have substantially increased interest in combining immunotherapy with other standard therapies in hepatocellular carcinoma, including those typically reserved for earlier stage disease, such as liver-directed therapies. Radioembolisation with Y90-resin microspheres followed by nivolumab for advanced hepatocellular carcinoma (CA 209-678): a single arm, single centre, phase 2 trialY90-radioembolisation followed by nivolumab resulted in an encouraging objective response rate in patients with advanced hepatocellular carcinoma, although the activity observed was not as high as the study was powered for. This strategy should be further evaluated in patients with Barcelona Clinic Liver Clinic (BCLC) stage B hepatocellular carcinoma that is ineligible or refractory to transarterial chemoembolisation and patients with BCLC C disease without extrahepatic spread. Full-Text PDF