Recent studies and expert insights reveal both progress and persistent challenges in the treatment of hepatocellular carcinoma (HCC). While advances in immunotherapy and combination therapies offer hope, rising incidence and mortality rates in the US underscore the need for improved screening and treatment strategies.
Screening for HCC Reduces Mortality
A study published in JAMA Network Open highlights the importance of screening for HCC in patients with known risk factors. The research found that patients whose HCC was detected via screening had a significantly lower mortality rate compared to those whose HCC was not detected through screening (42.3% vs 57.7%). Furthermore, patients with screen-detected HCC were more likely to receive curative treatment. These findings emphasize the critical role of early detection in improving patient outcomes.
Immunotherapy Advances in HCC Treatment
Amit Singal, MD, medical director of the Liver Tumor Program and chief of hepatology at University of Texas Southwestern Medical Center, noted the significant impact of immunotherapies on HCC treatment. "I think, in general, we've seen significant improvement in outcomes, responses, progression-free survival, and overall survival for patients across the board, given the introduction of immune checkpoint inhibitors in the therapeutic landscape," said Singal. The development of immunotherapies and combination regimens has extended the median survival for patients.
EMERALD-1 Trial: Durvalumab and Bevacizumab Plus TACE
The EMERALD-1 trial, presented at the American Society of Clinical Oncology Gastrointestinal Cancers Symposium, demonstrated that adding durvalumab (药物) and bevacizumab (药物) to transcatheter arterial chemoembolization (TACE) improved progression-free survival by almost 7 months in patients with unresectable HCC. TACE has been the standard of care for unresectable HCC for 20 years, but recurrence remains common. Cathy Eng, MD, FACP, FASCO, codirector of GI Oncology at Vanderbilt University Medical Center, stated that the results of EMERALD-1 "have the potential to establish a new standard of care for the treatment of unresectable hepatocellular carcinoma."
Study: Anti-PD-1 Addition to TACE Plus Lenvatinib Shows No Benefit
However, a small, retrospective, single-center study found that adding PD-1 inhibitors to TACE plus lenvatinib (药物) for HCC had no benefit over TACE plus lenvatinib alone. The study, published in June and including only 35 patients with unresectable HCC, suggests that the addition of PD-1 inhibitors may not always improve outcomes. The authors noted that the results needed to be validated in further research due to the small sample size, which limited subgroup analysis to determine if any subpopulations could benefit from the addition of PD-1 inhibitors more than other patients.
Increasing Incidence and Mortality Rates
Despite advances in treatment, a study published in the Journal of Clinical and Translational Hepatology revealed increasing incidence and mortality rates of HCC in the US. The study highlighted disparities between men and women in a range of racial/ethnic groups. While there was declining mortality in younger adults across racial and ethnic groups, the overall trend indicates a growing burden of HCC in the US.
