HCC how it’s done.

Unresectable hepatocellular carcinoma (HCC) doesn’t have any slam dunk options. Where can we turn? To immune checkpoint inhibitors, duh. While results with single-agent ICI have been disappointing, there’s been some success with atezolizumab combined with bevacizumab. On this novel phase 1 trial, 14 patients with unresectable HCC received stereotactic ablative radiation (SABR) 8 Gy x 5 to all (or dominant-only, if failing to meet mandated dose constraints) liver disease followed two weeks later by initiation of nivolumab alone (n=6) or nivo + ipilimumab (n=7) with a plan for two years total. Objective response rate occurred in zero with nivo alone versus four with combo ipi+nivo, translating to median survival times or 5 months versus 42(!) months, respectively. Albeit this is hypothesis-generating at best, SABR followed by combo ipi+nivo deserves further investigation as to whether it can meaningfully move the needle on outcomes across a larger population. | Juloori, Int J Radiat Oncol Biol Phys 2022