SG Leaders: Umberto Cillo
Alessandro Vitale
Summary:
Systemic treatment with immune-checkpoint-inhibitors has profoundly revolutionized the therapy of hepatocellular carcinoma (HCC), with relevant advantages in terms of objective response rate and duration of response. Novel systemic treatments have great potential as conversion therapies, i.e. determining successful downstaging and making radical surgery feasible in previously nonsurgical patients (converse therapeutic hierarchy).
We have proposed a new operative framework for decision-making in HCC patients based on the novel concept of multi-parametric therapeutic hierarchy. This concept needs to be validated in well-designed prospective studies, even though preliminary data from the literature have already shown promising results. However, some issues remain open. First, there are no validated clinical or molecular predictors of objective response rate or conversion ability after systemic therapy. Second, in the real world, many potential conversions don't translate into effective conversions to surgery, with a negative prognostic effect. Third, novel systemic therapies greatly impact health systems.
