Suppressing, stimulating and/or inhibiting: The evolving management of HCC patient after liver transplantation

Lorenza Di Marco; Adriana Romanzi; Alessandra Pivetti; Nicola De Maria; Federico Ravaioli; Massimiliano Salati; Erica Villa; Fabrizio Di Benedetto; Paolo Magistri; Massimo Dominici; Antonio Colecchia; Stefano Di Sandro; Andrea Spallanzani

doi:10.1016/j.critrevonc.2024.104607

Suppressing, stimulating and/or inhibiting: The evolving management of HCC patient after liver transplantation

Crit Rev Oncol Hematol. 2024 Dec 25:207:104607. doi: 10.1016/j.critrevonc.2024.104607. Online ahead of print.

Affiliations

¹ Department of Oncology and Hematology, Oncology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41124, Italy; Department of Biomedical, Metabolic and Neural Sciences, Clinical and Experimental Medicine Program, University of Modena and Reggio Emilia, Modena 41124, Italy. Electronic address: [email protected].
² Chimomo Department, Gastroenterology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy. Electronic address: [email protected].
³ Chimomo Department, Gastroenterology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy. Electronic address: [email protected].
⁴ Chimomo Department, Gastroenterology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy. Electronic address: [email protected].
⁵ Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna 40138, Italy. Electronic address: [email protected].
⁶ Department of Oncology and Hematology, Oncology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41124, Italy. Electronic address: [email protected].
⁷ Chimomo Department, Gastroenterology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy; National Institute of Gastroenterology IRCCS "Saverio de Bellis", Research Hospital, Castellana Grotte 70013, Italy. Electronic address: [email protected].
⁸ Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy. Electronic address: [email protected].
⁹ Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy. Electronic address: [email protected].
¹⁰ Department of Oncology and Hematology, Oncology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41124, Italy. Electronic address: [email protected].
¹¹ Chimomo Department, Gastroenterology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy. Electronic address: [email protected].
¹² Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41125, Italy. Electronic address: [email protected].
¹³ Department of Oncology and Hematology, Oncology Unit, University Hospital of Modena and Reggio Emilia, University of Modena and Reggio Emilia, Modena 41124, Italy. Electronic address: [email protected].

PMID: 39725094
DOI: 10.1016/j.critrevonc.2024.104607

Abstract

Liver transplantation (LT) is a curative strategy for hepatocellular carcinoma (HCC), but the risk of HCC recurrence remains a challenging problem. In patients with HCC recurrence after LT (HCC-R_LT), the locoregional and surgical approaches are complex, and the guidelines do not report evidence-based strategies for the management of immunosuppression. In recent years, immunotherapy has become an effective option for patients with advanced HCC in pre-transplant settings. However, due to the risk of potentially fatal allograft rejection, the use of immunotherapy is avoided in post-transplant settings. Combining immunosuppressants with immunotherapy in transplant patients is also challenging due to the complex tumor microenvironment and immunoreactivity. The fear of acute liver rejection and the lack of predictive factors hinder the successful clinical application of immunotherapy for post-liver transplantation HCC recurrence. This review aims to comprehensively summarize the risk of HCC-R_LT, the available evidence for the efficacy of immunotherapy in patients with HCC-R_LT, and the clinical issues regarding the innovative management of this patient population.

Keywords: Acute liver rejection; Atezolizumab; Bevacizumab; HCC; HCC recurrence; Immune checkpoint inhibitors; Liver transplantation; Pembrolizumab; TKIs.

Publication types

Review