Why Adjuvant and Neoadjuvant Therapy Failed in HCC. Can the New Immunotherapy Be Expected to Be Better?
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REVIEW ARTICLE
Why Adjuvant and Neoadjuvant Therapy Failed in HCC. Can the New Immunotherapy Be Expected to Be Better? Mustafa Dikilitas 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction HCC remains a challenging disease with its unique characteristics and aggressive behavior. Although there are some curative-intent treatments such as liver transplantation and surgical resection, they themselves did not cure the patients with relatively high recurrence rates. Several modalities including local ablation methods like TACE or TARE, systemic treatments such as chemotherapy, tyrosine kinase inhibitors or antiviral therapies are tested in adjuvant or neoadjuvant setting, but none of them offered a survival benefit (except antiviral therapy in HBV-related HCC). Conclusion After a decade of plateau in drug development, ICPIs came into podium with their different mechanism of action consistent with immunogenic nature of the disease and with high expectations, and ongoing trials will show if these agents can satisfy unmet demand in this area. Keywords Adjuvant . Neoadjuvant . Immunotherapy
Introduction Hepatocellular carcinoma (HCC) is the most common liver cancer worldwide, representing the third most common cancer in men and seventh in women [1, 2]. Despite the other common types of cancer, the incidence of HCC is increasing predominantly in men (fourfold higher in men than women), and this is valid for all major demographic groups and populations [3, 4]. For HCC, a major cause of cancer-related death, several locoregional and systemic treatments are available; however, only surgical resections, ablative therapies, and liver transplantation (LT) consist curative-intent options. Removing both the tumor and underlying liver disease LT seems the best option for this group of patients, but limited number of available organ donors all around the world and also limiting criteria which make the patient uneligible for transplantation are the main obstacles. Although the best results are restricted to small sized tumors, ablation is another reasonable option [5]. Given the factors mentioned above, surgical resection
* Mustafa Dikilitas [email protected] 1
Department of Medical Oncology, Inonu University Liver transplantation İnstitute, Malatya, Turkey
remains the most common curative treatment option for HCC patients. These patients absolutely have chronic liver disease (CLD) and some degree of cirrhosis, and as for all types of treatments recruited in HCC, the condition of the remnant liver determines the eligibility of surgical resections. On the other hand, recurrence rates after surgical resections is relatively high [6], and this is not only related with inadequate surgery (i.e., positive surgical margins) but also and frequently with developing de novo tumors in the course of the disease. Therefore, in order to improve the results of curative-intent options, especially of surgical resection, it is obvious that some additional treatment modalities are essential, and in this
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