In this final episode of the four-part series on hepatocellular carcinoma (HCC), hosted by the Oncology Brothers, Drs Rohit and Rahul Gosain, the discussion focuses on the evolving role of immunotherapy (IO) in intermediate HCC.

The episode explores multimodal approaches that combine IO and IO-based therapies with loco-regional treatments and highlights the essential role of a multidisciplinary care team.

Drs Nina Sanford (radiation oncologist), Mark Yarchoan (medical oncologist), and Ed Kim (interventional radiologist) join the Oncology Brothers to share their insights on:

• Current treatment options for intermediate HCC, addressing its heterogeneity and standard treatment pathways

• Latest clinical trial data (EMERALD-1, LEAP-012) on combining IO with loco-regional therapies, and the clinical implications

• The importance of effective collaboration within the multidisciplinary team for delivering optimal patient care

• Combining IO with loco-regional therapy and future perspectives in the field

Clinical takeaways

• IO and IO-based treatments are moving earlier in the treatment paradigm for patients with intermediate HCC. Earlier integration of these therapies aims to achieve improved systemic control, allowing loco-regional therapy to target oligoprogression, residual lesions or reduce tumour burden

• Emerging data supports combining systemic and loco-regional therapies for patients with intermediate HCC. EMERALD-1 and LEAP-012 show promising PFS data using IO-based combination regimens like durvalumab + bevacizumab or pembrolizumab + lenvatinib alongside TACE. Long-term OS data are awaited

• Effective communication and coordinated care among specialists, such as medical oncologists, radiation oncologists, hepatologists, and interventional radiologists, are essential to developing optimal treatment strategies for patients with intermediate HCC

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