Hepatocellular Carcinoma: The Evolving Role of Systemic Therapies as a Bridging Treatment to Liver Transplantation

Author:

Saleh Yacob1ORCID,Abu Hejleh Taher1,Abdelrahim Maen2,Shamseddine Ali3ORCID,Chehade Laudy3ORCID,Alawabdeh Tala1,Mohamad Issa4ORCID,Sammour Mohammad1,Turfa Rim1

Affiliation:

1. Department of Internal Medicine, King Hussein Cancer Center, Amman 11941, Jordan

2. Section of GI Oncology, Houston Methodist Neal Cancer Center, Houston, TX 77030, USA

3. Division of Hematology and Oncology, Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon

4. Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan

Abstract

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths. Classically, liver transplantation (LT) can be curative for HCC tumors within the Milan criteria. Bridging strategies to reduce the dropouts from LT waiting lists and/or to downstage patients who are beyond the Milan criteria are widely utilized. We conducted a literature-based review to evaluate the role of systemic therapies as a bridging treatment to liver transplantation (LT) in HCC patients. Tyrosine kinase inhibitors (TKIs) can be used as a systemic bridging therapy to LT in patients with contraindications for locoregional liver-directed therapies. Immune checkpoint inhibitor (ICI) treatment can be utilized either as a monotherapy or as a combination therapy with bevacizumab or TKIs prior to LT. Acute rejection after liver transplantation is a concern in the context of ICI treatment. Thus, a safe ICI washout period before LT and cautious post-LT immunosuppression strategies are required to reduce post-LT rejections and to optimize clinical outcomes. Nevertheless, prospective clinical trials are needed to establish definitive conclusions about the utility of systemic therapy as a bridging modality prior to LT in HCC patients.

Publisher

MDPI AG

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