Evolving Landscape in Liver Transplantation for Hepatocellular Carcinoma: From Stage Migration to Immunotherapy Revolution

Liver transplantation (LT) represents the primary curative option for HCC. Despite the extension of transplantation criteria and conversion with down-staging loco-regional treatments, transplantation is not always possible. The introduction of new standards of care in advanced HCC including a combin...

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Bibliographic Details
Published in:Life (Basel, Switzerland) Switzerland), 2023-07, Vol.13 (7), p.1562
Main Authors: Cesario, Silvia, Genovesi, Virginia, Salani, Francesca, Vasile, Enrico, Fornaro, Lorenzo, Vivaldi, Caterina, Masi, Gianluca
Format: Article
Language:English
Subjects:
Ablation
bridging
Cancer
Cancer therapies
Care and treatment
Clinical trials
combination treatment
Criteria
down-staging
Drug therapy
Graft rejection
Hepatocellular carcinoma
Hepatoma
Immune checkpoint inhibitors
Immunotherapy
Inhibitors
Ipilimumab
Kinases
Liver
Liver cancer
Liver transplantation
Methods
Patient outcomes
Patients
Protein-tyrosine kinase
Radiation therapy
Review
School dropout programs
Thrombosis
Transplantation
Transplants & implants
Tyrosine
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Summary:Liver transplantation (LT) represents the primary curative option for HCC. Despite the extension of transplantation criteria and conversion with down-staging loco-regional treatments, transplantation is not always possible. The introduction of new standards of care in advanced HCC including a combination of immune checkpoint inhibitor-based therapies led to an improvement in response rates and could represent a promising strategy for down-staging the tumor burden. In this review, we identify reports and series, comprising a total of 43 patients who received immune checkpoint inhibitors as bridging or down-staging therapies prior to LT. Overall, treated patients registered an objective response rate of 21%, and 14 patients were reduced within the Milan criteria. Graft rejection was reported in seven patients, resulting in the death of four patients; in the remaining cases, LT was performed safely after immunotherapy. Further investigations are required to define the duration of immune checkpoint inhibitors, their minimum washout period and the LT long-term safety of this strategy. Some randomized clinical trials including immunotherapy combinations, loco-regional treatment and/or tyrosine kinase inhibitors are ongoing and will likely determine the appropriateness of immune checkpoint inhibitors' administration before LT.
ISSN:2075-1729
2075-1729
DOI:10.3390/life13071562