APPLE 2023

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. In recent years, with the continuous improvement of diagnosis and treatment, the misdiagnosis rate and mortality of early-stage HCC have greatly decreased. However, many patients are already at an advanced stage when liver cancer is detected, making curative treatment impossible. For these inoperable HCC (uHCC) patients, how to maximize the rescue of the patient's life remains a major challenge. The emergence of local treatments, targeted therapies, immunotherapies, and multidimensional combined treatments has promoted the transition of uHCC patients to earlier stages, enhancing their survival benefits. In 2022, the leading international journal, The Lancet Gastroenterology & Hepatology, published a single-arm Phase II clinical study called START-FIT by Dr. Zhiren Chen's team from the University of Hong Kong, China. This study assessed the efficacy and safety of TACE, SBRT, and PD-L1 inhibitors in treating patients with locally advanced uHCC. At the 13th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2023), the team presented the latest 3-year follow-up data from the START-FIT trial, garnering widespread attention. This report provides a comprehensive overview.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Most patients are diagnosed at intermediate or advanced stages. The formation of portal vein tumor thrombus (PVTT) is a significant indicator of advanced HCC, with over half of late-stage HCC patients presenting with PVTT. Especially VP4 type (main portal vein), these patients usually have a poor prognosis. Most phase III clinical trials have excluded these patients. Lenvatinib is a new multi-targeted small molecule inhibitor now approved for advanced HCC. In Asian populations, Lenvatinib combined with a PD-1 inhibitor has shown good antitumor activity and safety. Radiotherapy has also brought about positive outcomes for HCC patients with PVTT. The 13th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2023) was held in Seoul, Korea, from July 6-8, 2023. At the conference, the team from the affiliated Beijing Tsinghua Chang Gung Hospital, Tsinghua University, China, reported on a clinical study (Abstract Number: PE-117), exploring the preliminary efficacy and safety of Lenvatinib combined with a PD-1 inhibitor and radiotherapy in HCC patients with main portal vein tumor thrombus. Hepatology Digest invited Dr. Guangxin Li to share insights on the study and its clinical prospects.

Hepatocellular carcinoma (HCC) is the most common malignant liver tumor in our country, posing a significant threat to the lives and health of our people. Presently, the treatment for advanced HCC is primarily systemic therapy based on targeted and immunotherapy. Deciding on the appropriate multi-target inhibitors and immunotherapies for combined treatment is a hot topic in current research. At the recently concluded 13th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2023), researchers from the Hong Kong Polytechnic University, China, presented a study (Abstract Number: OP-07) that reveals the mechanism of the wild-type Kras gene in HCC immune evasion. This research suggests that combining KRAS inhibitors might enhance the immunotherapeutic response in liver cancer patients, earning it the honor of an outstanding oral report. We have compiled and edited the findings of this study for our readers.