Neo-adjuvant therapy for hepatocellular carcinoma before liver transplantation:Where do we stand?

Liver transplantation (LT) for hepatocellular carcinoma (HCC) within Milan criteria is a widely accepted optimal therapy. Neo-adjuvant therapy before transplantation has been used as a bridging therapy to prevent dropout during the waiting period and as a down-staging method for the patient with intermediate HCC to qualify for liver transplantation. Transarterial chemoembolization and radiofrequency ablation are the most commonly used method for locoregional therapy. The data associated with newer modalities including drug-eluting beads, radioembolization with Y90, stereotactic radiation therapy and sorafenib will be discussed as a tool for converting advanced HCC to LT candidates. The concept “ablate and wait” has gained the popularity where mandated observation period after neo-adjuvant therapy allows for tumor biology to become apparent, thus has been recommended after down-staging. The role of neo-adjuvant therapy with conjunction of “ablate and wait” in living donor liver transplantation for intermediate stage HCC is also discussed in the paper.

Transarterial infusion chemotherapy with FOLFOX for advanced hepatocellular carcinoma:a multi-center propensity score matched analysis of real-world practice

Background:To compare the treatment effectiveness and safety among transarterial infusion chemotherapy(TAI)with FOLFOX regimen,transarterial chemoembolization(TACE),and sorafenib in patients with BCLC stage C hepatocellular carcinoma(HCC).Methods:The data of consecutive patients with BCLC stage C HCC treated with TAI,TACE,or sorafenib from January 2015 to December 2018 at three centers were retrospectively analyzed.Propensity-score matched(PSM)analysis was pairwise performed to reduce selection bias.Treatment effectiveness and safety were evaluated and compared using the Kaplan-Meier method,log-rank test,Cox regression models,andχ2 test.Results:The median overall survival(OS)in the matched TAI cohort was significantly longer than the sorafenib cohort(19.6 vs.7.5 months,P=0.009),and the TACE cohort(estimated 27.8 vs.6.6 months,P<0.001).The difference in median progression-free survival(PFS)between the matched TAI and sorafenib cohorts was not significant(5.8 vs.2.3 months,P=0.219).The median PFS in the matched TAI cohort was significantly longer than the TACE cohort(6.5 vs.2.8 months,P<0.001).The objective response rate(ORR)in the matched TAI cohort was significantly higher than the sorafenib cohort(36.4%vs.0.0%,P<0.001)and the TACE cohort(48.7%vs.4.7%,P<0.001).The incidences of adverse events(AEs)were similar among these three cohorts.Conclusions:TAI with FOLFOX regimen was an effective and safe therapy that improved survival of patients with BCLC stage C HCC.