Combination Therapies for Primary Liver Cancer

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is also one of the more challenging cancers to treat. HCC had historically been resistant to medical therapy, and few patients qualified for potentially curative surgical resection or liver transplant. The Barcelona Clinic Liver Cancer (BCLC) guidelines prescribe therapies for each HCC stage. For example, ablation is a first-line treatment for early stage HCC up to 3 cm. Combination therapies enable the extension of potentially curative therapies to patients with higher stages of cancer or otherwise challenging disease that would otherwise be offered only palliative therapies. Combining chemoembolization and ablation has been shown to provide improved outcomes for patients with HCC between 3 and 7 cm who are ineligible for surgery. Combination medical and locoregional therapies have been shown to be effective in several phase III trials in both concurrent and adjuvant settings. Promising studies have evaluated combination therapies involving external radiation and surgical resection.