Neoadjuvant and Adjuvant Systemic Therapies in Loco-Regional Treatments for Hepatocellular Carcinoma: Are We at the Dawn of a New Era?

• Published in: Cancers Vol. 15; no. 11; p. 2950
• Main Authors: Nevola, Riccardo, Delle Femine, Augusto, Rosato, Valerio, Kondili, Loreta Anesti, Alfano, Maria, Mastrocinque, Davide, Imbriani, Simona, Perillo, Pasquale, Beccia, Domenico, Villani, Angela, Ruocco, Rachele, Criscuolo, Livio, La Montagna, Marco, Russo, Antonio, Marrone, Aldo, Sasso, Ferdinando Carlo, Marfella, Raffaele, Rinaldi, Luca, Esposito, Nicolino, Barberis, Giuseppe, Claar, Ernesto
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 27.05.2023; MDPI
• Subjects: Ablation; Adjuvant treatment; Antimitotic agents; Antineoplastic agents; Cancer; Cancer therapies; Development and progression; Drug therapy; Health aspects; Hepatocellular carcinoma; Hepatoma; Immune checkpoint inhibitors; Immunotherapy; Lee, J.H; Liver; Liver cancer; Liver cirrhosis; Liver diseases; Liver transplantation; Malignancy; Medical prognosis; Metastasis; Monoclonal antibodies; Patients; Precision medicine; Response rates; Review; Solid tumors; Survival; Transplantation; Transplants & implants; Tumors; Finland; recurrence; adjuvant therapy; immune checkpoint inhibitors; neoadjuvant therapy; hepatocellular carcinoma; immunotherapy
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15112950

Despite maximizing techniques and patient selection, liver resection and ablation for HCC are still associated with high rates of recurrence. To date, HCC is the only cancer with no proven adjuvant or neoadjuvant therapy used in association to potentially curative treatment. Perioperative combination treatments are urgently needed to reduce recurrence rates and improve overall survival. Immunotherapy has demonstrated encouraging results in the setting of adjuvant and neoadjuvant treatments for non-hepatic malignancies. Conclusive data are not yet available in the context of liver neoplasms. However, growing evidence suggests that immunotherapy, and in particular immune checkpoint inhibitors, could represent the cornerstone of an epochal change in the treatment of HCC, improving recurrence rates and overall survival through combination treatments. Furthermore, the identification of predictive biomarkers of treatment response could drive the management of HCC into the era of a precision medicine. The purpose of this review is to analyze the state of the art in the setting of adjuvant and neoadjuvant therapies for HCC in association with loco-regional treatments in patients not eligible for liver transplantation and to hypothesize future scenarios.