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Review
. 2023 Apr:115:102526.
doi: 10.1016/j.ctrv.2023.102526. Epub 2023 Mar 2.

Clinical consensus statement: Establishing the roles of locoregional and systemic therapies for the treatment of intermediate-stage hepatocellular carcinoma in Canada

Jason K Wong  1 , Howard J Lim  2 , Vincent C Tam  3 , Kelly W Burak  4 , Laura A Dawson  5 , Prosanto Chaudhury  6 , Robert J Abraham  7 , Brandon M Meyers  8 , Gonzalo Sapisochin  9 , David Valenti  10 , Setareh Samimi  11 , Ravi Ramjeesingh  12 , Amol Mujoomdar  13 , Ilidio Martins  14 , Elijah Dixon  15 , Maja Segedi  16 , David M Liu  17
Affiliations
Review

Clinical consensus statement: Establishing the roles of locoregional and systemic therapies for the treatment of intermediate-stage hepatocellular carcinoma in Canada

Jason K Wong et al. Cancer Treat Rev. 2023 Apr.

Abstract

Background: Hepatocellular carcinoma (HCC) a leading cause of cancer mortality worldwide and approximately one-third of patients present with intermediate-stage disease. The treatment landscape of intermediate-stage HCC is rapidly evolving due to developments in local, locoregional and systemic therapies. Treatment recommendations focused on this heterogenous disease stage and that take into account the Canadian reality are lacking. To address this gap, a pan-Canadian group of experts in hepatology, transplant, surgery, radiation therapy, nuclear medicine, interventional radiology, and medical oncology came together to develop consensus recommendations on management of intermediate-stage HCC relevant to the Canadian context.

Methods: A modified Delphi framework was used to develop consensus statements with strengths of recommendation and supporting levels of evidence graded using the AHA/ACC classification system. Tentative consensus statements were drafted based on a systematic search and expert input in a series of iterative feedback cycles and were then circulated via online survey to assess the level of agreement.

Results & conclusion: The pre-defined ratification threshold of 80 % agreement was reached for all statements in the areas of multidisciplinary treatment (n = 4), intra-arterial therapy (n = 14), biologics (n = 5), radiation therapy (n = 3), surgical resection and transplantation (n = 7), and percutaneous ablative therapy (n = 4). These generally reflected an expansion in treatment options due to developments in previously established or emergent techniques, introduction of new and more active therapies and increased therapeutic flexibility. These developments have allowed for greater treatment tailoring and personalization as well as a paradigm shift toward strategies with curative intent in a wider range of disease settings.

Keywords: Hepatocellular carcinoma; Intermediate-stage disease; Locoregional therapy; Radiotherapy; Surgery; Systemic therapy.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Robert J Abraham has served as Chief Medical Officer for and holds stock of ABK Biomedical Inc., has served as a consultant or advisor to Eisai Canada and holds patents WO2012101524A2 and WO2020082168A1. Kelly W Burak has received honoraria from CADTH, Health Canada. Prosanto Chaudhury has received honoraria from Astellas, Ipsen, AstraZeneca, Novartis, and Wyeth. Laura A Dawson has served as President and Chair of ASTRO (non-compensated) and received research funding (through institution; as a co-investigator) from Merck. Elijah Dixon declares no conflicts of interest. Howard J Lim has received Honoria from Ipsen, Merck, BMS, Taiho, Eisai, Roche and AstraZeneca and research funding from Roche, Eisai and AstraZeneca. David M Liu has served as consultant for Eisai Pharm, Sirtex Medical and Varian System, and received honoraria from Ipsen Pharma and AstraZeneca. Ilidio Martins declares no conflicts of interest. Brandon Meyers has served as a consultant or advisor to Roche, Eisai, Ipsen, Incyte, Bayer, Merck, and AstraZeneca, research funding from Roche and provided expert testimony for Roche and Eisai. Amol Mujoomdar has served as a consultant or advisor to and received honoraria from Boston Scientific, Terumo Medical, Esai, Teleflex, and Medtronic. Ravi Ramjeesingh has served as a consultant or on an advisory board for AstraZeneca, Incyte, Eisai and Ipsen, has received honoraria from AstraZeneca, Incyte, Eisai, Ipsen and Bayer and has received research funding from Eisai, Pfizer, AstraZeneca, Amgen and Ipsen. Setareh Samimi has served as an advisor for and received honoraria from Eisai and AstraZeneca. Gonzalo Sapisochin has served as consultant for AstraZeneca, Roche, Novartis, Integra, Evidera, Chiesi and has received grant support from Roche and Bayer. Maja Segedi received honoraria from Eisai. David Valenti has served as an advisor to Eisai Canada. Vincent C Tam has received honoraria from AstraZeneca, Eisai, Incyte, Ipsen, and Roche and research funding from AstraZeneca, Eisai, Ipsen, and Roche. Jason K Wong has served as a consultant or advisor to and received honoraria from AstraZeneca, BD, Boston Scientific, Cook Medical, Eisai, Medtronic, and Roche.

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