Improving the Conversion Success Rate of Hepatocellular Carcinoma: Focus on the Use of Combination Therapy with a High Objective Response Rate

Abstract

The high mortality rate in hepatocellular carcinoma (HCC) is partially due to the fact that a significant number of patients are diagnosed at an intermediate or advanced stage, with surgical treatment options unavailable. Conversion therapy, which involves both locoregional and systemic treatments, has the potential to downstage tumors in selected patients with initially unresectable HCC, thereby making surgical treatment a possibility and potentially increasing long-term survival. To optimize the conversion rate, it is necessary to maximize successful conversions and clearly define the target population for conversion treatment through a collaborative effort. In this review article, we summarize the clinical experience and evidence for conversion therapy in patients with 'potentially resectable' HCC from four perspectives: 1) defining the target population for conversion therapy, 2) selecting the appropriate conversion strategy, placing emphasis on the utilization of combination therapy that exhibits a significant objective response rate, 3) determining the timing and urgency of surgical resection, 4) promoting the adoption of a multidisciplinary team model. The authors are optimistic that with the continuous progress in treatment and a deeper understanding of HCC, the success rate of HCC conversion therapy will increase, and the overall survival of HCC patients will be prolonged.

Keywords: Combination therapy; Conversion rate; Conversion therapy; Hepatocellular carcinoma; Targeted population.

Fig. 1. Illustration for conversion therapy in patients with “potentially resectable” hepatocellular carcinoma from four perspectives.

1) defining the target population for conversion therapy, 2) selecting the appropriate conversion strategy, 3) determining the timing and urgency of surgical resection, and 4) promoting the adoption of a multidisciplinary team model. MDT, multidisciplinary team; NAFLD, non-alcoholic fatty liver disease.

Fig. 2

HCC, hepatocellular carcinoma; CNLC, China liver cancer staging; FLR, future liver remnant; ALPPS, associating liver partition and portal vein ligation for staged hepatectomy; PVE, portal vein embolization; SBRT, stereotactic radiotherapy; RFA, radiofrequency ablation; MWA, microwave ablation.