The Role Of Immunotherapy in

Hepatocellular Carcinoma (HCC)

dr. Lisa
 Objectives
• Definition and Risk Factors of HCC
• Pathophysiology of HCC
• surveillance and Diagnostic of HCC
• Treatments of HCC
• Rule of immunotherapy in HCC
• To Understand what immunotherapy check point inhibitors are and
how they can help to fight cancer
• To understand what pd-1 inhibitors do and when might they be used
• To understand what ctla-4 inhibitors does and when it might be used
 Hepatocellular Carcinoma (HCC)

is the most common primary liver malignancy and is a

leading cause of cancer-related death worldwide.
Rising New Case and Deaths from Liver Cancer

https://seer.cancer.gov/statfacts/html/livibd.htm
l
RISK FACTORS AND PROGRESSION TO HCC
Pathophysiology of
HCC
Surveillance and Diagnostic

AASLD_2018_HCC_Guidance_on_Diagnosis,_Staging_and_Management_hep_29913
 Surveillance

1. A. The AASLD recommends the surveillance of adults with cirrhosis because it

improves overall survival (OS). Quality/Certainty of Evidence: Moderate Strength of
Recommendation: Strong

1.B. He AASLD recommends surveillance using the US, with or without AFP,
every 6 months. Quality/Certainty of Evidence: Low Strength of
Recommendation: Conditional

1.C. The AASLD recommends not performing surveillance of patients with

cirrhosis with Child’s class C unless they are on the transplant waiting list,
given the low anticipated survival for patients with Child's C cirrhosis.
Quality/Certainty of the Evidence: Low Strength of Recommendation:
Conditional
 Surveillance

• an Ultrasound (US) exam is considered negative if there are no focal

abnormalities or if only benign lesions such as cysts are identified.
• An exam is considered nondiagnostic if lesions are measuring <10 mm that are
not benign.
• An exam is considered positive if lesions are measuring≥10 mm.
• AFP is considered positive if its value is >20 ng/mL and negative if lower
 multiphase CT or MRI
in selected patients

AASLD_2018_HCC_Guidance_on_Diagnosis,_Staging_and_Management_hep_29913
 Diagnostic
2. The AASLD recommends diagnostic eval[1]uation for HCC with either multiphase CT or
multiphase MRI because of similar diagnostic per[1]formance characteristics. Quality/Certainty of
Evidence: Low for CT ver[1]sus MRI Strength of Recommendation: Strong

3.A. AASLD suggests several options in patients with cirrhosis and an

indeterminate nodule, including follow-up imaging, imaging with an alternative
modality of alternative contrast agent, or biopsy, but cannot recommend one
option over the other. Quality/Certainty of Evidence: Very low Strength of
Recommendation: Conditional

3B. The AASLD suggests against routine biopsy of every indeterminate nodule.
Quality/Certainty of Evidence: very low Strength of Recommendation:
conditional
 Diagnostic

AASLD_2018_HCC_Guidance_on_Diagnosis,_Staging_and_Management_hep_29913
 Diagnostic
HCC diagnostic criteria according to Barcelona EASL Conference

• Cyto-histological
• Non-invasif criteria (especially for patients with liver cirrhosis) :
 radiology criteria : coinciden 2 imaging (USG/CT-
SPiral,/MRI/angiography
- focal lession > 2cm with artery hypervascularization. (combination
criteria : one imaging with serum AFP:
- focal lession > 2cm with artery hypervascularization
- APF serum level ≥ 400 ng/ml.
 Multidisciplinary Team

Treatments depend on
How much liver is affected
Whether cancer spreads or not
Patient preferences and Overall Health
What are immune checkpoint inhibitors ?
Sharma & Allison (2015) Cell. 161(2):205-14