Introduction

In this episode, Dr. Tyler Sandow (Ochsner Health) interviews interventional radiologists Dr. Edward Kim (Mount Sinai) and Dr. Terence Gade (University of Pennsylvania) about the future directions of hepatocellular carcinoma (HCC) treatments, specifically focusing on the adoption of precision medicine and multidisciplinary approaches.

They delve into various HCC treatments, such as locoregional therapies like transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), as well as the roles of systemic immunotherapies and checkpoint inhibitors. They highlight the importance of sequential order and timing of treatments and the use of imaging biomarkers for individualized cancer care.

Throughout the discussion, influential clinical trials in HCC treatment are discussed and summarized. The doctors unanimously agree that as the sphere of interventional oncology is rapidly evolving, the focus should be centered on providing the most effective and patient-specific care with a deep understanding of combination therapies.

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SHOW NOTES

00:00 - Introduction

05:45 - The Beginnings of Systemic Therapy for HCC

08:28 - The Role of Immunotherapy in HCC Treatment

11:09 - Multidisciplinary Clinics and Tumor Boards

20:21 - The Society of Interventional Oncology and Treatment Guidelines

24.59 - Choosing Between Locoregional and Combination Therapies

39:17 - The Use of Immunotherapy in Early Stage Patients

42:08 - Current Safety Data for Immunotherapy

48.56 - TACE Drug Choice

53:16 - How to Approach Treatment of Multifocal or Large Tumors

01:00 - Timeline for Imaging to Assess Treatment Response

01:03 - The Future of Immunotherapy and Interventional Oncology

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RESOURCES

Society of Interventional Oncology (SIO):

https://www.sio-central.org/

Sorafenib in Advanced Hepatocellular Carcinoma (SHARP Trial)

https://www.nejm.org/doi/full/10.1056/nejmoa0708857

Efficacy and Safety of Sorafenib in Patients in the Asia-Pacific region with Advanced Hepatocellular Carcinoma:

https://pubmed.ncbi.nlm.nih.gov/19095497/

Efficacy and Safety of Nivolumab Plus Ipilimumab in Patients With Advanced Hepatocellular Carcinoma Previously Treated With Sorafenib (CheckMate 040 Trial):

https://jamanetwork.com/journals/jamaoncology/fullarticle/2771012

Tremelimumab and Durvalumab as First-line Therapy in Patients with Unresectable Hepatocellular Carcinoma (HIMALAYA Trial):

https://ascopubs.org/doi/10.1200/JCO.2022.40.4_suppl.379

Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma (IMbrave 150 Trial):

https://www.nejm.org/doi/full/10.1056/nejmoa1915745

Lenvatinib Combined With Transarterial Chemoembolization as First-Line Treatment for Advanced Hepatocellular Carcinoma (LAUNCH Trial):

https://ascopubs.org/doi/abs/10.1200/JCO.22.00392

Randomised, Multicentre Prospective Trial of Transarterial Chemoembolisation Plus Sorafenib as Compared with TACE Alone in Patients with Hepatocellular Carcinoma (TACTICS Trial):

https://pubmed.ncbi.nlm.nih.gov/31801872/

Uncoupling Immune Trajectories of Response and Adverse Events from Anti-PD-1 Immunotherapy in Hepatocellular Carcinoma:

https://pubmed.ncbi.nlm.nih.gov/35430299/

Personalised Versus Standard Dosimetry Approach of Selective Internal Radiation Therapy in Patients with Locally Advanced Hepatocellular Carcinoma (DOSISPHERE-01 Trial):

https://pubmed.ncbi.nlm.nih.gov/33166497/

Radiation Segmentectomy for Curative Intent of Unresectable Very Early to Early Stage Hepatocellular Carcinoma (RASER Trial):

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00091-7/fulltext

Immunotherapy and Transarterial Radioembolization Combination Treatment for Advanced Hepatocellular Carcinoma:

https://journals.lww.com/ajg/abstract/2023/12000/immunotherapy_and_transarterial_radioembolization.23.aspx

Find this episode on BackTable.com to see additional resources.