Enhancing HCC Treatment: Integrating Immunotherapy with Locoregional Therapies and Key Considerations

• Review ongoing trials on combining immunotherapy with locoregional treatments for hepatocellular carcinoma (HCC). 


• Discuss special considerations for locoregional therapy alongside immunotherapy.

HCC is a rapidly growing and often fatal cancer with a poor prognosis. Locoregional therapies such as transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and ablation provide effective, minimally invasive options for inoperable tumors. The advent of immunotherapy, particularly immune checkpoint inhibitors, opens new avenues for improving outcomes. Understanding the interactions between these concurrent treatments is crucial, as their combination can release tumor antigens and enhance immunotherapy effects through mechanisms like the abscopal effect. This review examines current research on integrating immunotherapy with locoregional therapies for HCC and explores special consideration for locoregional therapy alongside immunotherapy.

 

Clinical Findings/Procedure Details:

Recent advancements in cancer immunotherapy, as demonstrated by trials like HIMALAYA and IMbrave150, have reshaped the treatment landscape for HCC. The combination of locoregional therapies with systemic treatments is increasingly common, supported by trials confirming their safety and synergy. Currently, 19 trials explore ablation with immunotherapy, 54 investigate TACE, and 6 focus on TARE combined with immunotherapy. Trials on triple therapies, such as TACE combined with hepatic arterial infusion chemotherapy (HAIC), stereotactic body radiotherapy (SBRT), or ablation, are also underway. This session will review ongoing trials and data, focusing on potential complications of these combinations.

Special considerations for patients receiving immunotherapy include delaying anti-VEGF antibodies for 4-6 weeks before TACE or TARE to reduce vascular complication risks {1}. Anti-VEGF therapy can also lower lung shunt fractions in patients with high lung shunt percentages, making them eligible for TARE while minimizing radiation pneumonitis risk {2}

 

Conclusion and/or Teaching Points:

Integrating systemic therapies with locoregional treatments for HCC holds significant promise for improving outcomes. Staying updated on evolving research is essential for interventional radiologists to optimize treatment strategies and enhance patient care.