ECIO 2024: HCC in the spotlight

May 13, 2024

The role of interventional oncology in the treatment of hepatocellular carcinoma is expanding, and ongoing trials and new research point towards a more hopeful future in the treatment of the disease. In spite of this, many open questions on IO for HCC remain; what are the latest updates on combination strategies? Where does the interventional oncologist fit on the HCC tumour board? What role could AI play?

The floor was open for discussion at ECIO 2024 as experts from around the globe and numerous medical disciplines convened in Palma to attempt to answer these questions and many more on the treatment of HCC.

One of the very first sessions at ECIO 2024 concerned itself with combination strategies in the management of HCC, with topics including adjuvant therapies, downstaging before transplantation, TACE, TARE, and combination strategies in MDTs.

C. Toso began the session by presenting the newest data on clinical trials in adjuvant therapies, analysing these therapies and how they may impact patient selection for curative treatment. He concluded that, overall, adjuvant therapies for HCC still need the refinement of the studies that are currently underway, but that they could be justified in selected high risk surgical patients.

TACE received a lot of attention as well at this session, first with R. Iezzi asking if it’s time for standardization of combined ablation and TACE. He concluded that it’s time to push for standardized and optimized combined treatments, and that a future perspective RCT should look at ablation and TACE with adjuvant immunotherapy. M Kudo gave an update on TACE and systemic therapies, reviewing the data from several published and ongoing trials and discussing the possible impact on patient selection and management.

The session concluded with G. Masi speaking on the challenges of combination strategies and MDTs, a theme that would be elaborated on later in the day.

The “Why an IO should be on the tumour board: HCC” session on Sunday afternoon expanded on Prof. Masi’s closing thoughts from the morning and provided specific examples, case studies, and panel discussions on the of the positions of ablation, TACE, and TARE within today’s MDT.

Sunday also saw this year’s “Meet the PI” session. Among other cutting edge research, M. Burgmans presented on the PROMETHEUS study, a prospective multicentre study on quantitate analysis of ablation margins in HCC. He concluded that there is a lot of promise in quantitative margin analysis using co-registration, but a lot still needs to be learned, hopefully through PROMETHEUS and other studies investigating co-registration software, such as ACCLAIM and COVER-ALL.

AstraZeneca hosted a satellite symposium entitled “Multidisciplinary management of HCC in the era of multimodal treatments: evolving role of the Interventional Radiologist” in the afternoon. This symposium is open for everyone with a myCIRSE account to watch.

Incoming evidence and open debates

Monday’s “Best at ECIO: incoming evidence for liver tumours” session included two presentations on HCC-related trials.

First, G. Verset presented on the BIOPEARL-ONE trial, which is a prospective, single arm, multi-centre, post market clinical follow-up study looking at BioPearl™ resorbable drug-eluting microspheres loaded with Doxorubicin for transarterial chemoembolization (TACE) of HCC. The primary endpoints of the trial are the technical success and safety of the TACE procedure with Doxorubicin-loaded BioPearl™microspheres. The data is expected to point to Doxorubicin-loaded BioPearlTM microspheres being safe and effective for the treatment of unresectable HCC and potentially allowing multiple sequential TACE-procedures due to the recanalization of arteries.

J. Erinjeri presented on mRECIST outcomes in EMERALD-1. EMERALD-1 is a phase 3, randomized, placebo-controlled study of transarterial chemoembolization plus durvalumab with/without bevacizumab in participants with embolization-eligible unresectable HCC. This study concludes that Durvalumab combined with Bevacizumab and TACE significantly improved progression-free survival in comparison to TACE in participants with embolization-eligible uHCC. This supports Durvalumab+Bevacizumab+TACE as a potential new standard of care in uHCC.

The last HCC-focused session of the congress honed in on open debates in modern HCC treatment. A. Vitale began the session reviewing the current staging systems of HCC, speaking to the strengths and limitations of BCLC staging and proposing alternatives.

Further talks in the session concerned biopsy, advanced stage downstaging, the question of TARE or SBRT for radiation therapy, and where and why systemic treatment fails.

M. Ronot closed out the session with a hot topic for all of IO in a talk titled “AI and HCC: a happy marriage?” He reviewed current AI developments and how AI could guide decision-making and treatment planning in the future. He cautioned that there are many hurdles that must be overcome before AI can be extensively used in daily practice. “It’s going well…” he concluded “but the marriage has not been pronounced yet!”