Combination therapies plus transarterial chemoembolization in hepatocellular carcinoma: a snapshot of clinical trial progress

ABSTRACT

Introduction

Unfortunately, some hepatocellular carcinoma (HCC) patients do not qualify for curative-intent treatments such as surgical resection or transplantation. Hence, locoregional treatments such as transarterial chemoembolization (TACE) remain instrumental in the treatment of HCC. Systemic therapy has improved over the past decade with the introduction of combination atezolizumab and bevacizumab as the new standard of care for advanced disease. These new therapies are currently under investigation in combination with TACE.

Area covered

Combination therapies with TACE including systemic therapies, locoregional therapies, and immunotherapies are reviewed.

Expert opinion

There has been limited progress in the management of advanced and intermediate HCC. Recent advances in the management of advanced disease with systemic therapy could be beneficial in combination with TACE for the treatment of intermediate stage disease. Immune based therapies are potentially beneficial in combination with TACE because TACE may produce increased antigen release and immune recognition.

KEYWORDS:

• Hepatocellular carcinoma
• transarterial chemoembolization
• radiofrequency ablation
• immunotherapy
• locoregional therapy

Article highlights

• Transarterial therapies such as transarterial chemoembolization play an important role in the treatment of intermediate stage hepatocellular carcinoma.

• Sorafenib has been the standard systemic therapy in the treatment of hepatocellular carcinoma for nearly a decade, but there are now newer therapies such as the introduction of the immune checkpoint inhibitor atezolizumab in combination with bevacizumab.

• Transarterial therapies include transarterial embolization (TAE) with bland embolization beads, transarterial chemoembolization (TACE), drug eluting bead transarterial chemoembolization (DEB-TACE), and transarterial radioembolization (TARE); the ‘best’ method of embolization is still debated.

• The combination of TACE with sorafenib may improve response rates but has failed to demonstrate an improvement in overall survival.

• Transarterial therapy may allow for the systemic release of antigen, making immune therapies an attractive option in combination with TACE.

• There is no approved adjuvant therapy following ablation or resection for hepatocellular carcinoma; adjuvant TACE has failed to consistently demonstrate a survival benefit.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.