Neoadjuvant treatment strategies for hepatocellular carcinoma

Tumor thrombus infiltration of hepatocellular carcinoma (HCC) into the inferior vena cava and right atrium is rare and is associated with a poor prognosis due to the critical location of the tumor and the limited efficiency of the available treatment strategies. In this study, we report the case of a patient with advanced HCC and tumor thrombus in the inferior vena cava and right atrium who demonstrated complete response with mass retraction upon Yttrium-90 trans-arterial radioembolization (90Y- TARE) therapy. Throughout the 16 months follow-ups after the radioembolization, the patient was free of any complications, revealing no occurrence of radiation-induced pneumonitis or tumor recurrence.

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Prediction of Post-hepatectomy Liver Failure in Patients With Hepatocellular Carcinoma Based on Radiomics Using Gd-EOB-DTPA-Enhanced MRI: The Liver Failure Model

Frontiers in Oncology ◽

10.3389/fonc.2021.605296 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yuyan Chen ◽

Zelong Liu ◽

Yunxian Mo ◽

Bin Li ◽

Qian Zhou ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Failure ◽

Treatment Strategies ◽

Area Under The Curve ◽

Training Cohort ◽

Clinical Model ◽

Preoperative Prediction ◽

Medical Centers ◽

Appropriate Treatment ◽

Magnetic Resonance Imaging Mri

Objectives: Preoperative prediction of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) is significant for developing appropriate treatment strategies. We aimed to establish a radiomics-based clinical model for preoperative prediction of PHLF in HCC patients using gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).Methods: A total of 144 HCC patients from two medical centers were included, with 111 patients as the training cohort and 33 patients as the test cohort, respectively. Radiomics features and clinical variables were selected to construct a radiomics model and a clinical model, respectively. A combined logistic regression model, the liver failure (LF) model that incorporated the developed radiomics signature and clinical risk factors was then constructed. The performance of these models was evaluated and compared by plotting the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC) with 95% confidence interval (CI).Results: The radiomics model showed a higher AUC than the clinical model in the training cohort and the test cohort for predicting PHLF in HCC patients. Moreover, the LF model had the highest AUCs in both cohorts [0.956 (95% CI: 0.955–0.962) and 0.844 (95% CI: 0.833–0.886), respectively], compared with the radiomics model and the clinical model.Conclusions: We evaluated quantitative radiomics features from MRI images and presented an externally validated radiomics-based clinical model, the LF model for the prediction of PHLF in HCC patients, which could assist clinicians in making treatment strategies before surgery.

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Cancer Immunotherapy-Immune Checkpoint Inhibitors in Hepatocellular Carcinoma

Recent Patents on Anti-Cancer Drug Discovery ◽

10.2174/1574892816666210212145107 ◽

2021 ◽

Vol 16 ◽

Author(s):

Jing Bai ◽

Ping Liang ◽

Qian Li ◽

Rui Feng ◽

Jiang Liu

Keyword(s):

Hepatocellular Carcinoma ◽

Cell Death ◽

Programmed Cell Death ◽

Cancer Immunotherapy ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Treatment Strategies ◽

Locoregional Therapy ◽

Incidence And Mortality

: Hepatocellular Carcinoma (HCC) is one of the most common malignancies, the incidence and mortality of which are increasing worldwide. Cancer immunotherapy has revolutionized cancer treatment in recent years. In particular, Immune Checkpoint Inhibitors (ICIs) as new therapeutic tools have demonstrated encouraging antitumor activity and manageable tolerability in HCC. Immunologic checkpoint blockade with antibodies targeting Programmed cell Death-1 (PD-1), Programmed cell Death Ligand-1 (PD-L1), and Cytotoxic T Lymphocyte-Associated protein-4 (CTLA-4) strengthens tumor immunity by restoring exhausted T cells. Although the efficacy of combination treatment strategies using ICIs combined with other ICIs, molecular targeted agents, systemic therapy, or locoregional therapy has been well documented in numerous preclinical and clinical studies on several types of cancers, most HCC patients do not benefit from ICI treatment. This review highlights recent developments and potential opportunities related to ICIs and their combination in the management of HCC. The present article also includes recent patent review coverage on this topic.

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Adjuvant and Neoadjuvant Therapy for Pancreatic Adenocarcinoma

10.2310/7800.16076 ◽

2017 ◽

Author(s):

Gregory C Wilson ◽

Brent T Xia ◽

Syed A Ahmed

Keyword(s):

Pancreatic Cancer ◽

Adjuvant Therapy ◽

Neoadjuvant Therapy ◽

Pancreatic Adenocarcinoma ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Advanced Pancreatic Cancer ◽

Treatment Strategies ◽

Ductal Adenocarcinoma ◽

Borderline Resectable

Despite decades of advancement and research into the multimodal care of pancreatic cancer, mortality after the diagnosis of pancreatic ductal adenocarcinoma remains grim. The role of adjuvant therapy following surgical resection has been well established in the literature. However, adjuvant therapy is imperfect, and outside of a clinical trial, there are high rates of omission or delayed initiation of therapy. Neoadjuvant treatment strategies continue to be explored in the management of resectable, borderline-resectable, and locally advanced unresectable pancreatic adenocarcinoma. With improved resection rates and the possibility for tumor downstaging, neoadjuvant therapy has become standard for patients with borderline-resectable and locally advanced unresectable tumors. Additional benefits of neoadjuvant therapy in the treatment of resectable tumors include improved completion rates of systemic therapy and R0 resection rates. Future clinical trials, including the use of novel treatment agents and combination treatment strategies in both neoadjuvant and adjuvant regimens, will add value to the treatment of pancreatic adenocarcinoma. Key words: adjuvant therapy, borderline-resectable pancreatic cancer, locally advanced pancreatic cancer, neoadjuvant therapy, pancreatic adenocarcinoma, resectable disease

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Treatment strategies and prognosis for initially unresectable ruptured hepatocellular carcinoma: a single-center experience in 94 patients

Diagnostic and Interventional Radiology ◽

10.5152/dir.2019.19049 ◽

2020 ◽

Vol 26 (3) ◽

pp. 223-229

Author(s):

Chun Zhou ◽

◽

Qing-Quan Zu ◽

Xing-Long Liu ◽

Bin Wang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Treatment Strategies ◽

Single Center ◽

Single Center Experience ◽

Ruptured Hepatocellular Carcinoma

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Prognostic Role of Serum Cytokeratin-19 Fragment (CYFRA 21-1) in Patients with Hepatocellular Carcinoma

Cancers ◽

10.3390/cancers12102776 ◽

2020 ◽

Vol 12 (10) ◽

pp. 2776 ◽

Cited By ~ 1

Author(s):

Gian Paolo Caviglia ◽

Michela Ciruolo ◽

Antonella Olivero ◽

Patrizia Carucci ◽

Emanuela Rolle ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Cox Regression ◽

Treatment Strategies ◽

Stem Cell Marker ◽

Rank Test ◽

Cytokeratin 19 ◽

Serum Samples ◽

Cox Regression Analysis ◽

Keratin 19 ◽

New Diagnosis

Keratin 19 (K19) is a cancer stem cell marker expressed by a subpopulation of hepatocellular carcinoma (HCC), associated with tumor aggressiveness. We evaluated the prognostic value of serum K19 fragment (CYFRA 21-1), in comparison or in combination with alpha-fetoprotein (AFP) and protein induced by vitamin-K absence or antagonist-II (PIVKA-II), in patients with HCC. A total of 160 patients (28F/132M; median age 62, range 44–86 years) with a new diagnosis of HCC and available serum samples collected at tumor diagnosis were analyzed retrospectively. Median overall survival (OS) after HCC diagnosis was 35.1, 95% CI 27.1–70.5 months. Multivariate Cox regression analysis showed that CYFRA 21-1 > 2.7 ng/mL (hazard ratio (HR) = 3.39, p < 0.001), AFP > 20 ng/mL (HR = 2.27, p = 0.007), and PIVKA-II > 200 mAU/mL (HR = 2.17, p = 0.020) were independent predictors of OS. The combination of biomarkers positivity allowed us to stratify patients with HCC into four risk categories associated with a progressively lower survival probability (log-rank test, p < 0.001). CYFRA 21-1 resulted an independent prognostic factor of patients with HCC and its combination with AFP and PIVKA-II might be useful to tailor personalized treatment strategies.

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Current locoregional therapies and treatment strategies in hepatocellular carcinoma

Current Oncology ◽

10.3747/co.27.7171 ◽

2020 ◽

Vol 27 (S3) ◽

Author(s):

L. Cardarelli-Leite ◽

A. Hadjivassiliou ◽

D. Klass ◽

J. Chung ◽

S.G.F. Ho ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Tumor Biology ◽

Treatment Strategies ◽

Current Evidence ◽

Percutaneous Ablation ◽

Transarterial Radioembolization ◽

Combined Use ◽

Liver Morphology ◽

Locoregional Therapies ◽

Bridging To Transplant

Locoregional therapies (LRT) play an important role in the treatment of hepatocellular carcinoma (HCC), with the aim of increasing overall survival while preserving liver function. Different forms of LRT are available and choosing which one is best will depend on technical aspects, liver morphology, tumor biology, and patient’s symptoms. The purpose of this review article is to provide an overview of the current evidence regarding the use of percutaneous ablation, transarterial chemoembolization and transarterial radioembolization for the curative or palliative treatment of HCC. Special situations are also reviewed, including the combined use of systemic therapy with LRT; indications and techniques for bridging to transplant and downstaging; and the use of LRT to treat patients with HCC and macrovascular invasion.

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Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis

Annals of Surgical Oncology ◽

10.1245/s10434-020-08615-2 ◽

2020 ◽

Vol 27 (11) ◽

pp. 4319-4336 ◽

Cited By ~ 1

Author(s):

S. Hoendervangers ◽

J. P. M. Burbach ◽

M. M. Lacle ◽

M. Koopman ◽

W. M. U. van Grevenstein ◽

...

Keyword(s):

Systematic Review ◽

Rectal Cancer ◽

Pathological Complete Response ◽

Meta Analysis ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Treatment Strategies ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer

Abstract Background Pathological complete response (pCR) following neoadjuvant treatment for locally advanced rectal cancer (LARC) is associated with better survival, less local recurrence, and less distant failure. Furthermore, pCR indicates that the rectum may have been preserved. This meta-analysis gives an overview of available neoadjuvant treatment strategies for LARC and analyzes how these perform in achieving pCR as compared with the standard of care. Methods Pubmed, Embase, and Cochrane Central bibliographic databases were searched. Randomized controlled trials in which patients received neoadjuvant treatment for MRI-staged nonmetastatic resectable LARC were included. The primary outcome was pCR, defined as ypT0N0. A meta-analysis of studies comparing an intervention with standard fluoropyrimidine-based chemoradiation (CRT) was performed. Results Of the 17 articles included in the systematic review, 11 were used for the meta-analysis. Addition of oxaliplatin to fluoropyrimidine-based CRT resulted in significantly more pCR compared with fluoropyrimidine-based CRT only (OR 1.46), but at the expense of more ≥ grade 3 toxicity. Other treatment strategies, including consolidation/induction chemotherapy and short-course radiotherapy (SCRT), did not improve pCR rates. None of the included trials reported a benefit in local control or OS. Five-year DFS was significantly worse after SCRT-delay compared with CRT (59% vs. 75.1%, HR 1.93). Conclusions All included trials fail to deliver high-level evidence to show an improvement in pCR compared with standard fluoropyrimidine-based CRT. The addition of oxaliplatin might result in more pCR but at the expense of more toxicity. Furthermore, this benefit does not translate into less local recurrence or improved survival.

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