ESMO E-Learning: Advances in the Treatment of Hepatocellular Carcinoma (HCC)

In this E-Learning module, the authors put into clinical context a plethora of recent advances in the management of patients with hepatocellular carcinoma. They elaborate locoregional therapies, radioembolisation as an ablative therapy, and provide in depth insights into recent advances in systemic treatment, in particular immune checkpoint blockade as the first-line treatment option, sequencing with tyrosine kinase inhibitor after treatment with immune checkpoint inhibitor, the combination treatments, and management with other targeted therapies.

The authors start the module by elaborating the definition of advanced stage disease with vascular invasion or tumour spread outside the liver at diagnosis or at recurrence/progression to locoregional therapy and the definition of intermediate or early disease stages in patients who are not candidates to locoregional therapies, particularly in scenarios when tumours are too numerous and/or too large to be treated selectively and tumours that progressed to prior locoregional therapies.

The authors support considerations for all treatment modalities, elaborated in this module by providing key findings from clinical studies and illustrate their place in management with algorithms from the ESMO clinical practice guideline. With regard to clinical practice, the module provides tips for the selection of patients for certain treatment options, although the authors recognise the challenges faced in patient stratification and treatment selection. Clinical tips for current management opportunities are followed by perspectives from future research and continuing efforts to optimise management strategies.

In this module, the authors emphasize that multidisciplinary evaluation is key. They underline that liver function should be preserved at all stages to allow sequential therapies. Atezolizumab plus bevacizumab and durvalumab plus tremelimumab are the preferred options in patients receiving front-line treatment for advanced hepatocellular carcinoma. Sequential therapy is strongly advised in advanced hepatocellular carcinoma, but optimal sequences need to be established. Immune checkpoint blockade is moving towards earlier stages of the disease with several ongoing studies addressing the combination with local therapies. Biomarkers identification would be key in evolving treatment for hepatocellular carcinoma.