SIR 2024
Interventional Oncology
Camden Macdowell, PhD
Medical Student
Rutgers, Robert Wood Johnson Medical School
Disclosure information not submitted.
Eleanor C. Lee, MPH
Medical Student
University of Tennessee Health Science Center
Financial relationships: Full list of relationships is listed on the CME information page.
Geogy Vatakencherry, MD, FSVM,FSIR
Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
Financial relationships: Full list of relationships is listed on the CME information page.
1. Learn the first-line systemic immunotherapies for Hepatocellular Carcinoma and their associated evidence from randomized control trials.
2. Learn and apply recent evidence supporting combined medical-interventional approaches to treat HCC in select patient populations.
Background: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It carries a poor prognosis, with a median survival of 36 months if left untreated {1}. HCC occurs in a heterogeneous patient population, including patients with hepatitis B and C, alcoholic steatohepatitis, and metabolic steatohepatitis. Management of HCC is similarly multifaceted and includes systemic immunotherapy, transarterial chemoembolization (TACE), radioembolization, percutaneous ablation, surgical resection, and definitive treatment with liver transplant. Vascular and interventional radiology specialists are often primary providers for patients with HCC and a thorough knowledge of the treatment options and their applicability to different populations is critical for providing high-quality care. Here, we review the medical and interventional management of HCC and discuss recent evidence supporting the combined use of systemic immunotherapy and TACE in select patients.
Clinical Findings/Procedure Details: This exhibit will (1) review the systemic immunotherapies for HCC and their associated clinical trials including Sorafenib (SHARP {2}), Lenvatinib (REFLECT {3}), Bevacizumab plus Atezolizumab (IMBRAVE 150 {4}), and Tremelimumab plus Durvalumab (HIMALAYA III {5}); (2) review recent randomized control trial evidence supporting the combined use of systemic immunotherapy and interventional approaches for the management of HCC (Lenvatinib plus TACE, LAUNCH {6}) and discuss the applicability of such combined approaches to select patient populations; (3) discuss the efficacy of current medical and combined medical-interventional approaches on patient survival; (4) highlight ongoing randomized controlled trials studying combined medical-interventional therapies for HCC (e.g. EMERALD-1 {7}, CheckMate 74W {8}, and LEAP-012 {9}).
Conclusion and/or Teaching Points: Vascular and interventional radiologists routinely treat patients with HCC. A foundational understanding of the numerous therapies for HCC is necessary for educating patients and constructing appropriate treatment regimes. Systemic immunotherapies and interventional approaches are cornerstone therapies for many HCC patients. Combining these approaches may serve as an effective treatment option in select populations.