Up to seven criteria in selection of systemic therapy for hepatocellular carcinoma

Abstract

Barcelona clinic liver cancer (BCLC) intermediate stage hepatocellular carcinoma is a heterogenous disease. Transarterial chemoembolization is offered as the first line therapy in this disease stage. Recent advances in systemic therapy have markedly improved outcomes even in advanced stage disease. The use of systemic therapy in BCLC intermediate stage disease may now be of therapeutic benefit in selected patients. We will focus on “the up to seven” criteria and its utility in selecting systemic therapy.

Keywords: Chemoembolization; Hepatocellular carcinoma; Immunotherapy; Drug combinations; Review; Medical oncology

Core Tip: Barcelona clinic liver cancer intermediate stage disease that exceeds “the up to seven” criteria, especially with lesions larger than 5 cm, is less likely to respond to transarterial chemoembolization (TACE) alone and is therefore a disease that may respond better to systemic therapy. The use of “the up to seven” criteria can be a helpful guidepost for when to consider systemic therapy alone or in addition to TACE. With the recent breakthroughs in immunotherapy for advanced hepatocellular carcinoma which clearly demonstrated overall survival advantage over single agent tyrosine kinase inhibitors sorafenib, it is promising that the use of immunotherapy would likely lead to better outcome when used in intermediate disease.