Investigators Are Exploring Neoadjuvant and Adjuvant Therapy in HCC

Amit Singal, MD, medical director of the Liver Tumor Program and clinical chief of hepatology at the University of Texas Southwestern Medical Center, discusses options after surgical resection for patients with hepatocellular carcinoma (HCC).

Surgical resection is the treatment available to patients with HCC who are eligible. After resection, there is still remnant cirrhotic liver, and patients have recurrent disease 50% to 70% of the time within 5 years after surgery, according to Singal. Patients need to be followed closely after surgical resection with routine CT or MRI scans at 3- to 6-month intervals.

Adjuvant therapy has been a point of interest in the HCC setting, including tyrosine kinase inhibitors (TKIs), which have been investigated for efficacy. Singal says the most notable is adjuvant sorafenib (Nexavar) used after surgical resection in the STORM trial (NCT00692770). Although there was excitement for using TKIs in HCC, the sorafenib trial data were negative.

However, Singal says immune checkpoint inhibitors (ICIs) have revolutionized the approach to advance-stage HCC. This includes regimens like atezolizumab (Tecentriq) and bevacizumab (Avastin), which is now the standard of care for these patients. Other ICIs are now being evaluated in clinical trials in earlier stages of HCC as neoadjuvant and adjuvant therapy. Signal thinks this is exciting even though it’s still in early stages of trials.

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