A little known side effect with a huge impact

Neoadjuvant Immunotherapy Facilitates Surgery And Improves Outcomes For Patients With High-risk Liver Cancer: Study

Patients with liver cancer who received immune checkpoint inhibitors (ICIs) before surgery-including those who would not have been eligible for surgery by conventional criteria-had similar outcomes to patients who received surgery upfront, according to results from a retrospective study published in Cancer Research Communications, a journal of the American Association for Cancer Research (AACR).

Mari Nakazawa, MD, first author of the study and a clinical research fellow at the Johns Hopkins Kimmel Cancer Center; and Mark Yarchoan, MD, senior author of the study and an associate professor of oncology at the Johns Hopkins Kimmel Cancer Center.

While immunotherapy has become a mainstay for the treatment of advanced or metastatic liver cancer, the primary curative treatment modality for patients with early-stage disease is surgery alone. Only around 30% of patients are eligible for surgical resection due to factors such as tumor size, proximity to critical structures, the presence of multiple tumor foci, and safety concerns, explained Nakazawa. She added that even patients who receive curative intent surgery often experience a recurrence.

"There's a strong unmet need to expand the number of patients who may be eligible for surgery and, further, to transform more patients with early-stage liver cancer into long-term survivors of this disease," Nakazawa said.

Studies from other cancers have shown that neoadjuvant immunotherapy may mitigate some high-risk features and help unresectable tumors meet the eligibility criteria for surgery. It may also help the immune system destroy micrometastases, thereby preventing distant recurrences later. The authors hypothesized that neoadjuvant ICI therapy may help make surgery safer and more effective in patients with high-risk, localized liver cancer.

Nakazawa, Yarchoan, and colleagues retrospectively examined outcomes from 92 patients who underwent resection for hepatocellular carcinoma at Johns Hopkins from 2017 to 2023. This included 36 patients who received neoadjuvant ICI therapy, many of whom were treated under clinical trial protocols assessing the feasibility and efficacy of immunotherapy prior to surgery. Prior to receipt of immunotherapy, 61.1% of these patients would not have been candidates for curative surgery based on traditional surgical resection criteria.

Compared with patients who received surgery upfront, patients who received neoadjuvant ICIs more commonly exhibited high-risk disease features, including high serum alpha fetoprotein, tumors larger than 5 cm, portal vein invasion, and multiple tumor foci. High-risk features have previously been associated with worse outcomes.

In this study, however, patients who received neoadjuvant ICIs-who may have been expected to have worse outcomes due to high-risk features-had comparable outcomes to patients who received upfront surgery. Among those who received neoadjuvant ICIs, 94.4% underwent successful margin-negative surgical resection, and the median recurrence-free survival was 44.8 months, compared to 49.3 months among those treated with upfront surgery. The median overall survival was not reached in either cohort.

"This study shows that the criteria by which we classify patients as being candidates for curative therapy is probably too narrow for this disease," Yarchoan said.

The authors emphasized that these findings are retrospective and intended to be hypothesis generating, but they believe these data set a promising stage for future research. "Prospective trials that are thoughtfully designed in the right populations can help us understand which patients can benefit most from this approach," Nakazawa said.

"Our findings demonstrate that systemic therapy may not only be useful for patients with advanced disease but can potentially be paradigm changing in patients with early-stage disease," Yarchoan added. "There is a group of patients with high-risk liver cancer who, in a contemporary era, may have long-term survival through aggressive treatment with systemic therapy followed by surgery."

Limitations of this study include its retrospective, single-institution nature with a relatively small sample size. Further, as the study cohort was compiled from patients treated in several different clinical trials, as well as those who underwent upfront surgery as the standard of care, factors such as baseline disease characteristics, the duration of neoadjuvant immunotherapy (if received), use of locoregional therapies, and receipt of adjuvant immunotherapy differed between patients.

Reference:

Mari Nakazawa, Mike Fang, Tyrus Vong, Jane Zorzi, Paige Griffith, Robert A. Anders, Impact of Neoadjuvant Immunotherapy on Recurrence-Free Survival in Patients with High-Risk Localized HCC, Cancer Research Communications, https://doi.Org/10.1158/2767-9764.CRC-24-0151.

Medical Moment: Liquifying Liver Tumors

(WNDU) - More than 40,000 people will be told they have liver cancer this year.

30,000 will die from the disease.

It's considered the leading cause of cancer deaths worldwide. Traditional treatments include surgery, chemo and radiation.

Now, doctors have a new tool in their toolbox. A cutting-edge alternative so strong, it liquifies the tumor.

"The liver's an organ that can actually form many different types of cancers," said Dr. Eric Liu, neuroendocrine surgeon at Presbyterian St. Luke's Medical Center.

Liver, lung, colon, prostate, melanoma, breast cancers from all over the body can end up in the liver. And now, Dr. Liu is one of the first to use ultrasound to destroy them.

"It's a technique in which we can fire very, very high-powered ultrasound beams into the liver and we can actually dissolve the tumors directly without having to cut them open," said Dr. Liu.

Histotripsy uses 52 beams of ultrasound and can focus on a target as small as a BB.

"Do you remember when we were kids? And you could take a magnifying glass, and you could burn a leaf right on that one spot. We can do the same thing now for tumors in the liver," said Dr. Liu.

The tumor is liquified and destroyed on the spot! Then the body will rid itself of the liquid left behind. And unlike radiation, histotripsy does not impact the surrounding tissue and organs.

"The radiation can really damage a lot of the neighbors. The innocent bystanders nearby. Histotripsy is not like that," said Dr. Liu.

Giving doctors and patients another way to battle cancer and win.

Because this procedure is non-invasive, it can be done as many times as needed.

Right now, Histotripsy is only approved for liver tumors. But as technology advances, Dr. Liu hopes they will be able to use it on many more, if not all, types of tumors.

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Li Ka Shing Foundation Funds Non-invasive Liver Cancer Treatment For Hong Kong Patients

Hong Kong liver cancer patients can receive a painless treatment that uses ultrasound waves to destroy cancerous tissue after the Li Ka Shing Foundation donated Asia's first cutting-edge, non-invasive device to the city's oldest university. The University of Hong Kong's Li Ka Shing Faculty of Medicine unveiled the new histotripsy treatment during a press event at Queen Mary Hospital in Pok Fu Lam on Tuesday. The event also featured an appearance via live video link by business magnate Li Ka-shing, who waved to researchers and reporters as he hailed the new technology as "incredible".

The non-invasive ultrasound treatment will be offered to 20 hospital patients free of charge over the next two years as part of a research programme led by the university.

The first patient is expected to start treatment this week.

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