HCC: Year in Review With Dr. David S. Wang

During CIO 2023, David S. Wang, MD, clinical associate professor, radiology at Stanford Medicine summarized key developments in the management of hepatocellular carcinoma (HCC) over the past year.

 

As part of the Session 1: Year in Review at the 2023 Symposium on Clinical Interventional Oncology (CIO), David S. Wang, MD, clinical associate professor, radiology at Stanford University recently delivered a presentation summarizing the key developments in the management of hepatocellular carcinoma (HCC) over the past year. HCC was a main talking point at this year’s event, and Dr. Wang's presentation covered various important aspects of the year and the future of HCC management: 

Guideline Updates 

Dr. Wang began by emphasizing the importance of updated guidelines for HCC treatment. Notably, he discussed the changes made to the widely used Barcelona Clinic Liver Cancer (BCLC) staging system. The BCLC guidelines have become more sophisticated and flexible, accommodating patient-specific characteristics and local expertise in treatment decisions. Intermediate-stage patients have been further divided into distinct groups, including those who can be downstaged for liver transplant. The American Association for the Study of Liver Diseases and European Society of Medical Oncology also updated their guidelines for early and intermediate stage disease, closely following those of the BCLC guidelines.   

Renalization and Dosimetry 

The talk highlighted the complexity and significance of dosimetry in renalization, especially when using glass microspheres. Dr. Wang referred to updated dosimetry guidelines that have been developed and the need to consider clinical scenarios such as curative intent treatment and palliative approaches. 

Combination Therapies 

There is growing interest in combining local regional therapies with systemic therapies, believing that this approach may offer synergistic benefits. Dr. Wang mentioned several ongoing or recently presented phase 3 trials in HCC that explore this approach. 

IMBRAVE 150 Study 

Dr. Wang highlighted the IMBRAVE 150 study, which investigates adjuvant atezolizumab and bevacetamab treatments for patients over a 12-month period who have undergone curative intent resection or ablation, a population known to have a high risk of recurrence This study is significant as it demonstrated a 28% improvement in recurrence-free survival at one year, representing a new approach to HCC treatment. 

LAUNCH Trial 

The LAUNCH trial, conducted in China, focuses on patients with advanced HCC, specifically those with macroscopic portal vein invasion. The study aims to determine the effectiveness of adding transarterial chemoembolization (TACE) to imatinib, a systemic therapy. Preliminary results showed improvements in median overall survival, progression-free survival, and objective response, although the reasons for these effects remain unclear. 

Ablation Therapies 

Dr. Wang discussed the role of ablation therapies, particularly microablation. The three-centimeter cutoff for ablation is commonly based on radiofrequency ablation (RF) data. However, a Chinese study indicated that microablation can be similarly effective for tumors smaller than three centimeters, suggesting potential benefits for specific cases. 

Other Emerging Therapies 

The presentation mentioned other non-thermal, nonionizing radiation therapies, such as histotripsy and pulsed electric fields, which are still in the early stages of exploration for HCC. 

Cost-Effectiveness 

Dr. Wang also highlighted the importance of cost-effectiveness considerations in HCC treatments. A study from the University of California, San Francisco, demonstrated that for patients with small, solitary lesions eligible for transplantation, ablation is the most cost-effective bridging therapy. Further studies on cost-effectiveness for different disease stages and downstaging are expected.