Ep. 538 Immunotherapy and TACE in HCC Treatment with Dr. Julius Chapiro and Dr. Richard Finn
Apr 29, 2025
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Dr. Richard Finn, a medical oncologist at UCLA with expertise in liver cancer clinical trials, and Dr. Julius Chapiro, an interventional radiologist at Yale, delve into groundbreaking treatments for hepatocellular carcinoma. They discuss the synergy between transarterial chemoembolization (TACE) and immunotherapy, revealing how recent studies shift treatment paradigms. The duo emphasizes the need for a multidisciplinary approach, highlights advancements in biopsy techniques, and the importance of robust data in guiding treatment decisions.
Combining transarterial chemoembolization (TACE) with immunotherapy shows significant benefits, potentially changing treatment algorithms for hepatocellular carcinoma (HCC).
Multidisciplinary collaboration among oncologists, interventional radiologists, and hepatologists is essential for optimizing HCC patient management and outcomes.
High-quality clinical data from rigorous trials is crucial to advance interventional practices and bridge the gap between expertise and evidence.
Deep dives
Rapid Evolution in Hepatocellular Carcinoma Treatment
The field of hepatocellular carcinoma (HCC) is experiencing rapid advancements, particularly due to increasing interest from the pharmaceutical industry. This influx of resources provides a unique opportunity to enhance treatment strategies and conduct pivotal clinical trials that could reshape patient care. With significant funding for research, there is a strong push for multidisciplinary collaboration among healthcare providers, which is crucial to develop high-quality data that informs clinical practice. This evolution highlights the need for the medical community to take the lead in these initiatives to ensure they remain at the forefront of HCC treatment.
TACE and Immunotherapy Integration
Transarterial chemoembolization (TACE) plays a critical role in treating HCC, especially in combination with immunotherapy. The podcast discusses the evolving evidence suggesting that combining TACE with immunotherapeutic agents could lead to improved outcomes for patients, encouraging interventional radiologists and oncologists to consider this approach. The successful integration of these modalities appears to enhance treatment effectiveness, showcasing the importance of collaborative care in oncology. Furthermore, ongoing clinical trials are expected to shed light on the optimal sequencing and combinations of these therapies.
The Importance of Multidisciplinary Care
Multidisciplinary care is essential in managing HCC effectively, as it allows for comprehensive evaluation and treatment planning that considers all aspects of the patient’s condition. This collaborative approach involves input from medical oncologists, interventional radiologists, hepatologists, and transplant surgeons to optimize patient outcomes. The complexity of liver cancer necessitates this teamwork, particularly as treatment strategies become more nuanced and personalized. Data indicates that patients managed within a multidisciplinary framework tend to experience better survival rates and overall care.
Referral Patterns and Patient Management
The podcast outlines the referral patterns for patients with suspected HCC, emphasizing the significance of a structured approach within large health systems. Patients are typically referred through hepatology to liver cancer centers where multidisciplinary teams evaluate them. The involvement of specialists from various fields allows for tailored treatment plans, which enhances the management of liver cancer. Understanding these referral dynamics is crucial for ensuring that patients receive the appropriate care continuum and maximizing their treatment opportunities.
Need for High-Level Evidence in Interventional Practices
High-level evidence remains a cornerstone for advancing interventional practices in HCC treatment, and the podcast underscores the need for rigorous clinical trials in this area. It highlights the gap between clinical expertise and the evidence base that supports various treatment modalities like TACE and Y90 radioembolization. The discussion reflects a call to action for the interventional radiology community to prioritize study designs that yield robust evidence that can guide clinical decision-making. By focusing on the generation of high-quality data, practitioners can ensure their techniques and therapies are both effective and justifiable.
There are now multiple phase 3 studies on combination transarterial chemoembolization (TACE) and immunotherapy showing a significant benefit over TACE alone. How do these findings change the hepatocellular carcinoma (HCC) treatment algorithm? In this multidisciplinary episode of the BackTable Podcast, Dr. Richard Finn (Medical Oncologist at UCLA) and Dr. Julius Chapiro (Interventional Radiologist at Yale University) join host Dr. Chris Beck to discuss immunotherapy, TACE, emerging trends in HCC treatment, and the future of the field. --- This podcast is supported by an educational grant from Guerbet. --- SYNPOSIS The doctors highlight the importance of high quality clinical data and the pivotal studies shaping current best practices. They explore the role of the different players on the multidisciplinary team and compare the oncologic and radiologic perspectives. Additionally, they discuss the synergy between TACE and immunotherapy, the criteria for selecting appropriate treatments, and the ongoing need for research and collaboration. --- TIMESTAMPS 00:00 - Introduction 03:35 - HCC from an Oncologic Perspective 05:33 - Radiological Perspective on Liver Cancer 06:50 - Referral Patterns and Organizing a Multidisciplinary Approach 18:01 - Explaining TACE and Variations in the Procedure 27:27 - Choosing the Right Procedure for HCC 36:13 - Making a Decision on Medical Treatment Candidacy 42:23 - Importance of Data Driven HCC Treatment, Practical Insights, and Studies to Know 55:30 - Planning an Approach for a TACE Procedure 01:02:26 - Final Thoughts and Future Prospects in Liver Cancer Treatment --- RESOURCES Barcelona Staging System: https://www.ncbi.nlm.nih.gov/books/NBK569796/table/Ch3-t0001/ TRACE Trial: https://pubs.rsna.org/doi/full/10.1148/radiol.211806 PREMIERE Trial: https://www.gastrojournal.org/article/S0016-5085(16)34971-X/fulltext EMERALD-1 Trial: https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432 LEAP O12 Study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02575-3/abstract
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