Ouranos K, Chatziioannou A, Goulis I, Sinakos E. Role of immunotherapy in downsizing hepatocellular carcinoma prior to liver transplantation. World J Transplant 2022; 12(11): 331-346 [PMID: 36437845 DOI: 10.5500/wjt.v12.i11.331]
Corresponding Author of This Article
Konstantinos Ouranos, MD, 4th Medical Department, Hippokratio Hospital, Aristotle University of Thessaloniki, 49, Konstantinoupoleos Str, Thessaloniki 54642, Greece. kostassky@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Nov 18, 2022; 12(11): 331-346 Published online Nov 18, 2022. doi: 10.5500/wjt.v12.i11.331
Role of immunotherapy in downsizing hepatocellular carcinoma prior to liver transplantation
Konstantinos Ouranos, Anthi Chatziioannou, Ioannis Goulis, Emmanouil Sinakos
Konstantinos Ouranos, Anthi Chatziioannou, Ioannis Goulis, Emmanouil Sinakos, 4th Medical Department, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
Author contributions: Ouranos K drafted the article; Chatziioannou A contributed to the acquisition of analyses of data; Goulis I made critical revisions related to important intellectual content and approved the final version of the manuscript; Sinakos E designed the study, made critical revisions related to important intellectual content, approved the final version of the manuscript and supervised the project.
Conflict-of-interest statement: The authors have no conflict -of-interest to disclose relevant to this work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Konstantinos Ouranos, MD, 4th Medical Department, Hippokratio Hospital, Aristotle University of Thessaloniki, 49, Konstantinoupoleos Str, Thessaloniki 54642, Greece. kostassky@hotmail.com
Received: June 15, 2022 Peer-review started: June 15, 2022 First decision: August 1, 2022 Revised: August 10, 2022 Accepted: October 19, 2022 Article in press: October 19, 2022 Published online: November 18, 2022
Abstract
Hepatocellular carcinoma (HCC) is an aggressive primary liver neoplasm that, according to tumor stage, can be treated with resection, transplantation, locoregional treatment options, or systemic therapy. Although interventions only in early-stage disease can offer complete tumor regression, systemic therapy in advanced disease can significantly prolong overall survival, according to published clinical trials. The emergence of immunotherapy in the field of cancer therapy has had a positive impact on patients with HCC, resulting in atezolizumab–bevacizumab currently being the first-line option for treatment of advanced HCC. In light of this, application of immunotherapy in the preoperative process could increase the number of patients fulfilling the criteria for liver transplantation (LT). Implementation of this approach is faced with challenges regarding the safety of immunotherapy and the possibly increased risk of rejection in the perioperative period. Case reports and clinical trials assessing the safety profile and effectiveness of neoadjuvant immunotherapy, highlight important aspects regarding this newly evolving approach to HCC management. More studies need to be conducted in order to reach a consensus regarding the optimal way to administer immunotherapy prior to LT. In this review, we summarize the role, safety profile and future considerations regarding the use of neoadjuvant immunotherapy prior to LT in patients with HCC.
Core tip: Immunotherapy has been used in the treatment of advanced hepatocellular carcinoma (HCC) with promising results. Extending its use in the preoperative period prior to liver transplantation (LT), either alone or in combination with other locoregional treatment modalities, could increase the pool of potential LT candidates. Data from case reports and ongoing clinical trials assessing neoadjuvant immunotherapy prior to LT could revolutionize the current consensus regarding HCC downsizing practices and improve survival of patients with this type of malignancy.
