Immunotherapy for recurrent hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is presented frequently in late stages that are not amenable for curative treatment. Even for patients who can undergo resection for curative treatment of HCC, up to 50% recur. For patients who were not exposed to systemic therapy prior to recurrence, recurrence frequently cannot be subjected to curative therapy or local treatments. Such patients have several options of immunotherapy (IO). This includes programmed cell death protein 1 (PD-1) and cytotoxic T- lymphocyte associated protein 4 treatment, combination of PD-1 and vascular endothelial growth factor inhibitor or single agent PD-1 therapy when all other options are deemed inappropriate. There are also investigational therapies in this area that explore either PD-1 and tyrosine kinase inhibitors or a novel agent in addition to PD-1 with vascular endothelial growth factor inhibitors. This mini-review explored IO options for patients with recurrent HCC who were not exposed to systemic therapy at the initial diagnosis. We also discussed potential IO options for patients with recurrent HCC who were exposed to first-line therapy with curative intent at diagnosis.

Keywords: Liver neoplasms; Immune checkpoint blockade; Combination drug therapy; PD-1- PD-L1 blockade; CTLA-4 inhibitor.

Core Tip: Immunotherapy (IO) has made strong headway in the management of hepatocellular carcinoma (HCC). For patients who recur on local therapy, IO has become the standard of care treatment option for unresectable HCC. The role of IO agents is still not explored in patients who progress on prior IO. This mini-review highlighted the various treatment options available in clinical practice as well as upcoming novel management strategies in recurrent HCC.