Transarterial Chemoembolization Plus Immunotherapy for Patients With Hepatocellular Carcinoma

At Great Debates and Updates in Gastrointestinal Malignancies in New York, New York, Adam Talenfeld, MD, Weill Cornell Medicine, New York, New York, argued in favor of using transarterial chemoembolization alongside immune checkpoint blockade to treat patients with hepatocellular carcinoma.

Transcript:

Hi, I'm Adam Talenfeld, I'm an associate professor of clinical radiology at the Weill Cornell Medical Center of the New York Presbyterian Hospital. The debate that I participated in this year for the spring GDU GI Malignancies meeting is “Immune Checkpoint Inhibitors with Transarterial Chemoembolizatoin: Skip It or Do It?” And of course I'm going to tell you we need to do it. 

And the reason for that is two-fold. One is we know that transaterial therapies more broadly, and chemoembolization in particular, all of these therapies, like all locoregional therapies, they work, bottom line. We know that for example the latest data coming out on segmental ablative dose yttrium 90 transarterial radiation shows it to be similar in oncologic efficacy, for example time to progression, overall survival to surgical resection, even in patients who are sicker, and all this with fewer side effects.

We know that transarterial therapies work, we know that the same principle that exists, for example, in colorectal metastatic disease where fewer cancer cells mean longer survival is true in hepatocellular carcinoma as well. And we know furthermore that immune checkpoint blockade also works. 

I'm very happy to have been given the opportunity to be on the side of the low-hanging fruit for this debate because really it's an exciting time obviously in medical oncology and in the oncologic care for patients with hepatocellular carcinoma. We're at an inflection point in the systemic care for patients with HCC. And if you look at the IMBrave050 trial results, we're really now incorporating immune checkpoint blockade into AASLD and other treatment guidelines, Barcelona Clinic for Liver Cancer (BCLC) guidelines as appropriate adjuvant care for patients, even with intermediate stage disease now, not just those with advanced disease. And with the ASCO abstract presentation of the EMERALD-1 data now, we see that this is true also for neoadjuvant, even for patients that are pre-op, going for curative resection, curative-intent ablation.

By combining transarterial therapies, like chemoembolization or radioembolization, with immune checkpoint inhibitors, we can get the best of both worlds. It’s not a question of whether we use these therapies in combination. It's about what's the timing, what are the specific therapies that we're going to use, and in which patients. You know, we have something like upwards of 15 or 20 ongoing phase 2 and 3 trials of adjuvant and neoadjuvant immune checkpoint inhibitors, both with transarterial therapies and other locoregional therapies and in combinations with each other. So it's very exciting. 

It's just going to be a matter of trying to identify which are the patients that are going to benefit from which particular checkpoint blockade agents and which particular locoregional therapy, and the timing and the combination. But we know that by combining these treatments together, we're going to be able not just to downstage people to resectability, but prolong survival, as we've seen with the early study results, in all stages across the BCLC spectrum from early to intermediate and even advanced disease.

Source:

Talenfeld A. Debate: Transarterial chemoembolization for hepatocellular carcinoma with immune checkpoint blockade: Skip it or do it? Presented at Great Debates and Updates in Gastrointestinal Malignancies. May 17-18, 2024. New York, NY.