Editor’s Note: To help clinicians and researchers in the field of hepatology stay updated with academic knowledge and research trends, Hepatology Digest and the Journal of Clinical and Translational Hepatology (JCTH) jointly launched the “Journal Club” column. Every two weeks (Tuesday), one selected article is highlighted, focusing on key points or insights to improve clinical practice, inspire research thinking, and enhance writing skills.
This issue features a review by Professor Ming Zhao’s team from Sun Yat-sen University Cancer Center, summarizing clinical experiences and evidence on transformative treatments for “potentially resectable” hepatocellular carcinoma (HCC) patients from four perspectives. This review provides valuable reference for clinical decision-making in the transformative treatment of HCC patients.
HCC is a highly fatal malignancy, with many patients diagnosed at intermediate or advanced stages, rendering them ineligible for surgery. However, the advent of transformative treatments offers hope for these patients. Transformative treatment is an approach combining local and systemic therapies, potentially downstaging initially unresectable tumors to make surgical intervention feasible, thus improving long-term survival.
In this review, the authors summarize clinical experiences and evidence on transformative treatments for “potentially resectable” HCC patients from four perspectives. First, it is crucial to identify the target population for transformative treatment to select appropriate patients for therapy. Second, choosing the right transformative strategy is vital, particularly emphasizing the use of combined therapies with significant objective response rates. Third, determining the timing and urgency of surgical resection is critical, requiring decisions based on the patient’s specific condition. Finally, promoting a multidisciplinary team (MDT) approach can enhance the success rate of transformative treatment by leveraging the expertise and technologies of various specialties.
Recently, Vitale et al. proposed a new treatment hierarchy variant known as the reverse treatment hierarchy. Unlike the traditional treatment hierarchy, the reverse treatment hierarchy emphasizes that combining systemic and local treatments can increase the chances of curative treatment. Although this concept requires further clinical trials for validation, observational studies suggest that combining local and systemic treatments may achieve promising liver resection conversion rates. This new perspective challenges the traditional treatment hierarchy by recognizing the importance of systemic treatment in improving the aggressive biological behavior of tumors and expanding the indications for curative treatments to benefit more patients.
Despite significant progress in HCC treatment in recent years, optimizing transformative treatment remains challenging. Selecting combined therapies with higher tumor response rates is crucial for improving the success rate of transformation. To assist readers in better conducting transformative treatment, the authors propose a treatment pathway based on the latest knowledge, providing valuable reference for optimizing HCC patient transformation.
Results and Conclusions
Overall, with the continuous development of treatment options and increased understanding of HCC treatment, we remain optimistic about the success rate of transformative treatment for HCC. Through collaborative efforts, identifying the target population for transformative treatment, choosing the right transformation strategy, determining the optimal timing for surgery, and promoting the adoption of MDT approaches, we can improve the success rate of transformative treatment and extend the overall survival of HCC patients.
Author Bio
Corresponding Author:
Ming Zhao
Secretary of the Party Branch and Deputy Director of the Department of Minimally Invasive Interventional Therapy at Sun Yat-sen University Cancer Center, Chief Physician, Professor, and Doctoral Supervisor at the National Key Laboratory for Prevention and Treatment of South China Malignant Tumors. Professor Zhao’s achievements include pioneering the use of hepatic arterial infusion chemotherapy (FOLFOX regimen) as a first-line treatment for advanced HCC, which has been incorporated into the National Health Commission’s Guidelines for the Diagnosis and Treatment of Primary Liver Cancer and the CSCO Guidelines for Liver Cancer Diagnosis and Treatment. These guidelines have been cited by Korean (KLCA) and Japanese (JIS) guidelines. Professor Zhao has also participated in drafting multiple guidelines, including the 2019, 2021, and 2022 National Health Commission’s Guidelines for the Diagnosis and Treatment of Primary Liver Cancer, the 2018, 2020, and 2022 versions of the CSCO Guidelines for Liver Cancer Diagnosis and Treatment, the Clinical Practice Guidelines for TACE in China (2021 and 2023 editions), the ISMIO International HCC Expert Collaboration Group Consensus on TACE Clinical Practice (2021), and several MDT, transformation, and immunotherapy guidelines and consensuses. As the principal investigator, Professor Zhao has led numerous national, key R&D sub-projects, and international multicenter basic and clinical research projects.
