The Latest Updates and Ongoing Controversies in HCC Treatment: A Roundtable Discussion

At the 2023 Symposium on Clinical Interventional Oncology (CIO), Edward Kim, MD, Mount Sinai Health System, New York, New York, led a panel discussion exploring current hot topics in hepatocellular carcinoma (HCC).

Participating in the panel discussion were Fernando De Zarraga, MD, Miami Cancer Institute, Florida, Riad Salem, MD, MBA, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Raul Uppot, MD, Massachusetts General Hospital, Boston, and Ramon Jimenez, MD, Miami Cancer Institute. These experts come from various medical backgrounds relevant to the treatment of HCC, including medical oncology, radiology, and surgery. Each of the participants offered their expert opinions on important studies and ongoing controversies related to HCC in 2023 and beyond. 

The discussion began with an overview of two significant studies: the NRG RTOG 0915 and the IMbrave150 trials. The NRG RTOG 0915 trial is a randomized phase 3 study that examined the efficacy of stereotactic body radiation therapy (SBRT) versus sorafenib in the treatment of HCC. The panel scrutinized the outcomes of the trial, emphasizing the potential implications and controversies surrounding the findings.

The panel raised questions about the statistical significance of the results, especially when considering the efficacy of sorafenib in comparison to other treatments available for HCC. The survival data for the sorafenib arm seemed notably high in this trial, making it a subject of discussion, and the panel recognized the widespread use of sorafenib, particularly in 2023, and its continued popularity among physicians.

Despite the potential positive outcomes, the experts also recognized the need for further research into combining SBRT with other therapies, with an emphasis on optimizing treatment strategies. They highlighted the inclusion criteria of these trials, stating that it is crucial to pay attention to what is included when analyzing results.

The conversation then shifted to the IMbrave150 study, which focused on adjuvant therapy for high-risk HCC patients who had undergone curative procedures. The panel considered the eligibility criteria for ablation and the significance of micrometastases in HCC. The experts discussed the potential implications of the study and the necessity of overall survival data to determine the efficacy of adjuvant therapies.

The question of whether the benefits of adjuvant therapies, like atezolizumab, could be extended to other therapies was also raised. While the panel acknowledged the promise of atezolizumab, they also recognized that other therapies might have similar effects, emphasizing the need for further comprehensive investigations.

The panel discussion shed light on the complex landscape of HCC treatment. It underlined the significance of ongoing research, the optimization of treatment strategies, and the need for comprehensive data to make informed decisions in the battle against HCC.