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Review
. 2021 Dec 15;13(12):1896-1918.
doi: 10.4251/wjgo.v13.i12.1896.

Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

Zeno Sparchez  1 , Pompilia Radu  2 , Adrian Bartos  3 , Iuliana Nenu  1 , Rares Craciun  1 , Tudor Mocan  1 , Adelina Horhat  1 , Mihaela Spârchez  4 , Jean-François Dufour  5
Affiliations
Review

Combined treatments in hepatocellular carcinoma: Time to put them in the guidelines?

Zeno Sparchez et al. World J Gastrointest Oncol. .

Abstract

The time for battling cancer has never been more suitable than nowadays and fortunately against hepatocellular carcinoma (HCC) we do have a far-reaching arsenal. Moreover, because liver cancer comprises a plethora of stages-from very early to advanced disease and with many treatment options-from surgery to immunotherapy trials-it leaves the clinician a wide range of options. The scope of our review is to throw light on combination treatments that seem to be beyond guidelines and to highlight these using evidence-based analysis of the most frequently used combination therapies, discussing their advantages and flaws in comparison to the current standard of care. One particular combination therapy seems to be in the forefront: Transarterial chemoembolization plus ablation for medium-size non-resectable HCC (3-5 cm), which is currently at the frontier between Barcelona Clinic Liver Cancer classification A and B. Not only does it improve the outcome in contrast to each individual therapy, but it also seems to have similar results to surgery. Also, the abundance of immune checkpoint inhibitors that have appeared lately in clinical trials are bringing promising results against HCC. Although the path of combination therapies in HCC is still filled with uncertainty and caveats, in the following years the hepatology and oncology fields could witness an HCC guideline revolution.

Keywords: Hepatocellular carcinoma; Immunotherapy combined treatments; Microwave ablation; Radiofrequency ablation; Systemic therapy; Transarterial chemoembolization.

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Conflict of interest statement

Conflict-of-interest statement: Jean-François Dufour: Advisory committees: Abbvie, Bayer, BMS, Falk, Genfit, Genkyotex, Gilead Science, HepaRegenix, Intercept, Lilly, Merck, Novartis. Speaking and teaching: Abbvie, Bayer, BMS, Genfit, Gilead Science, Novartis.

Figures

Figure 1
Figure 1
The place of combined therapy in the Barcelona clinic liver cancer classification algorithm. 1Lesion not seen at ultrasound or in inappropiate positions; 2Lesion > 3 cm; 3Within Up-to-seven criteria. ABL: Ablation; HR: Hepatic resection; IOP: Intraoperatiove ablation; IT: Immunotherapy; LT: Liver transplantation; LRT: Locoregional therapy; OLT: Orthotopic liver transplantation; TACE: Transarterial chemoembolization; TARE: Transarterial radioembolization; TKI: Tyrosine kinase inhibitors.
See this image and copyright information in PMC

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