Immunotherapies for Hepatocellular Carcinoma: Quick Reference for the Interventional Radiologist

1. Summarize updated guidelines regarding the role of immunotherapy in hepatocellular carcinoma (HCC) treatment.

2. Review the clinical use of immunotherapy agents in HCC treatment, including evidence from landmark clinical trials, treatment regimens, and known adverse effects.

3. Discuss existing literature and ongoing studies for immunotherapy regimens combined with interventional locoregional therapies for HCC.

Background:

The Barcelona Clinic Liver Cancer (BCLC) staging criteria is one of the most widely used guidelines for evaluating disease severity and management of HCC. {1} In 2018, the BCLC guidelines recommended sorafenib as the first-line systemic immunotherapy for advanced stage HCC, and this represented the standard of care for years. {2,3} Now, the updated 2022 BCLC guidelines recommend Atezolizumab-Bevacizumab and Tremelimumab-Durvalumab as first-line therapies, due to improved overall survival as published by trials such as IMbrave150 and HIMALAYA. {4,5} However, these new therapies may bring different risks and side effect profiles. For example, bevacizumab carries a known increased risk for bleeding and vascular injury, which may increase the risk of complications in patients who have received bevacizumab and seek subsequent transarterial therapies for HCC management. {6,7,8} Thus, it is crucial for interventional radiologists to stay informed about this continuously evolving landscape, as interventionalists involved in HCC management will inevitably encounter increasing numbers of patients undergoing these treatments. Aside from current treatment strategies, there is also expanding interest in the combination of systemic immunotherapy with locoregional therapies (e.g. ablation, transarterial embolization), as these are hypothesized to create changes in the local tumor microenvironment that potentiate the activity of immunotherapies. {9,10}

Clinical Findings/Procedure Details:

This exhibit summarizes the currently available evidence on immunotherapy agents used for HCC treatment, as well as current evidence and efforts in developing treatment strategies combining immunotherapy with interventional locoregional therapies.

Conclusion and/or Teaching Points:

It is vital that interventional radiologists stay abreast of the evidence and potential adverse effects of immunotherapies in the treatment of HCC. Increasing numbers of patients receiving these therapies will be under the care of interventionalists, and new combined treatment strategies incorporating both locoregional therapies and immunotherapies are on the horizon.