Patients With HCC May Avoid Additional Treatment After Complete Response

A watch-and-wait strategy may be feasible for patients with locally advanced hepatocellular carcinoma (HCC) who achieve a complete response after receiving locoregional therapy (LRT) and immunotherapy (I/O).¹ These findings may spare patients additional, needless therapy and improve their quality of life.^2,3

Without additional treatment, patients achieved a durable response with long-term survival after radiological, according to new research published in JAMA Oncology.¹

Patients with locally advanced hepatocellular carcinoma who achieve a complete response after locoregional therapy and immunotherapy may be able to follow a watch-and-wait protocol.

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Up to half of patients with locally advanced HCC achieve complete remission after a combination of LRT plus I/O. However, the study authors note, “This promising response presents a new challenge for clinicians regarding the optimal treatment” after patients achieve a complete response due to the lack of long-term outcomes data for these patients. The researchers conducted a post hoc analysis of the outcomes for these patients with HCC who received the combination of LRT and I/O. Patients in their study were diagnosed and treated at Queen Mary Hospital in Hong Kong, China; Tuen Mun Hospital, also in Hong Kong, China; or the University of Hong Kong-Shenzhen Hospital, in Shenzhen, China.

Patients were treated with transarterial chemoembolization (TACE) on day 1 followed by 5 fractions of stereotactic body radiotherapy (SBRT) on day 28 and I/O 14 days after SBRT and for every 2 weeks after. Patients were placed on close surveillance without surgical treatment if they achieved CR, and they underwent CT or MRI of the abdomen every 3 months and CT of the thorax every 4 to 6 months. Every 3 months, patients underwent a physical examination.

A total of 63 patients were included, with the majority (92.1%) being men and a median age of 69 years (range, 18-90 years). The median follow-up time was 34.7 months. There were 33 patients who received a combination of sequential TACE and SBRT followed by I/O; 16 patients who received combined TACE, SBRT, and I/O; and 14 patients who received SBRT combined with I/O.

Almost half (46.0%) of patients treated achieved a complete response, 28.6% achieved a partial response, 9.5% achieved stable disease, and 15.9% experienced disease progression. The median time to achieving a complete response was 5.4 months (95% CI, 4.7-7.3 months) and the median duration of the complete response was 25.7 months (95% CI, 23-6-36.3 months).

Of the patients who achieved a complete response:

• 20.7% died due to HCC progression (n = 2), COVID-19 (n = 1), cardiac arrhythmia (n = 2), and cirrhosis (n = 1)
• 34.5% of patients relapsed
  • 6 patients had solitary intrahepatic disease relapse and received curative surgical treatment
  • 4 patients had multifocal or disseminated disease and were treated with palliative intent

Overall, the survival was “satisfactory” among the patients who achieved a complete response, the authors noted. The heterogeneity in the choice of LRT and I/O was one limitation of the study, as well as the lack of a control group. In addition, the generalizability of the study may be limited since 69.8% of the patients had hepatitis B–related HCC.

The findings of this study indicate additional randomized clinical trials are warranted, they concluded.

References

1. Chiang CL, Chan KSK, Chiu KWH, et al. Complete response to locoregional therapy plus immunotherapy for hepatocellular carcinoma. JAMA Oncol. 2024;10(11):1548-1553. doi:10.1001/jamaoncol.2024.4085

2. Fagerlie SR. Data show quality-of-life cost with watch-and-wait approach. Oncology News Central. December 15, 2023. Accessed November 25, 2024. https://www.oncologynewscentral.com/article/data-show-quality-of-life-cost-with-watch-and-wait-approach 

3. Piersol B. How a watch-and-wait approach may help people with rectal cancer preserve their quality of life. Memorial Sloan Kettering Cancer Center. January 15, 2019. Accessed November 25, 2024. https://www.mskcc.org/news/how-watch-and-wait-approach-may-help-people-rectal-cancer-preserve-their-quality-life