Dr Lencioni on Unmet Needs in Unresectable HCC

Riccardo Lencioni, MD, FSIR, EBIR, professor, director, Diagnostic Imaging and Intervention, Pisa University School of Medicine, discusses unmet needs in patients with unresectable hepatocellular carcinoma (HCC).

Although the HCC treatment armamentarium has substantially expanded in recent years, this disease remains challenging to manage, as patients continue to have a poor prognosis, Lencioni begins. A multidisciplinary approach is crucial to improving patient outcomes, he states. This involves a comprehensive assessment of all available therapies, including surgery, transplantation, ablation, embolization therapies, and the emerging field of immunotherapy-based systemic treatments, he details.

Lencioni states that it is essential to recognize that patients with HCC often face 2 concurrent challenges: managing the tumor itself and addressing underlying chronic liver disease. Therefore, patient selection is paramount, with careful consideration given to liver function and the risk of bleeding. Each patient's unique characteristics must be thoroughly evaluated to determine the most appropriate treatment approach for their specific situation, Lencioni emphasizes.

By adopting a multidisciplinary approach and conducting individualized assessments, healthcare providers can optimize treatment decisions and improve outcomes for patients with HCC, Lencioni reiterates. This comprehensive strategy ensures that patients receive tailored care that addresses both the tumor and the underlying liver disease, ultimately leading to better management of this complex condition, he states.

The phase 3 EMERALD-1 trial (NCT03778957) may usher in a new era in the treatment of patients with unresectable HCC by demonstrating, for the first time, the significant benefits of combining locoregional, liver-directed therapy with a systemically active drug, Lencioni elucidates. Findings from the final progression-free survival (PFS) analysis of the trial showed that patients treated with transarterial chemoembolization (TACE), durvalumab (Imfinzi), and bevacizumab (Avastin) achieved a median PFS of 15.0 months (95% CI, 11.1-18.9) vs 8.2 months (95% CI, 6.9-11.1) with TACE plus placebos (n = 205). These data were presented at the 2024 Gastrointestinal Cancers Symposium.

These data have the potential to redefine the standard of care for this patient population, offering a new treatment option that could address unique challenges and unmet needs in HCC, he concludes.