Role of locoregional therapies in the wake of systemic therapy

Daniel H. Palmer*, Katerina Malagari, Laura M. Kulik

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations

Abstract

Multiple systemic agents have recently been approved in the first- and second-line setting for hepatocellular carcinoma (HCC), increasing the therapeutic options for patients and treating physicians. The randomised controlled trials that led to these approvals were predominantly conducted in a population comprised of patients with advanced HCC. However, these trials also included a subset of patients who had progressed after locoregional therapies (LRTs), mostly transarterial chemoembolisation. With a greater number of systemic agents available, the role of LRTs has become a topic of debate, specifically regarding when to transition to systemic therapy in unresectable HCC and the potential opportunities for combining locoregional and systemic therapies. Trials of immuno-oncology agents (notably T cell checkpoint inhibitors) are ongoing in the advanced disease setting and these agents also present opportunities for combination therapies, both with other systemic agents and with LRTs in earlier stage disease. This article will review strategies to guide patient selection for LRT as well as the development of locoregional-systemic combinations based on scientific rationale and the challenges of clinical trial design in this setting.

Original languageEnglish (US)
Pages (from-to)277-287
Number of pages11
JournalJournal of Hepatology
Volume72
Issue number2
DOIs
StatePublished - Feb 2020

Keywords

  • Combination therapy
  • HCC
  • Immune checkpoint inhibitors
  • Sorafenib
  • TKI, TACE, TARE, embolization

ASJC Scopus subject areas

  • Hepatology

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