Treatment of intermediate-to-advanced unresectable hepatocellular carcinoma is shifting toward a multidisciplinary strategy that includes multiple modalities as needed

Abstract

In the recent issue of the World Journal of Gastroenterology, Han et al compared the efficacy of and adverse reactions to bevacizumab versus lenvatinib as molecularly targeted agents in combination with interventional therapy and immunotherapy (IMT) to treat intermediate-to-advanced unresectable hepatocellular carcinoma. No significant differences in efficacy or adverse reactions were observed between bevacizumab and lenvatinib. This study is highly promising because in some regions, e.g., Japan, the combination of molecularly targeted therapy with IMT is fixed because of insurance restrictions, and some molecularly targeted agents cannot be combined with IMT. Further studies using these three modalities are expected to be conducted in the future. Additionally, because advanced radiotherapy modalities have recently been established, the number of combinations continues to increase, and further evidence regarding combination therapy, which is the cornerstone of personalized medicine, needs to be accumulated.

Keywords: Hepatocellular carcinoma; Molecularly targeted therapy; Immunotherapy; Interventional therapy; Radiation therapy

Core Tip: Many treatment approaches for intermediate-to-advanced unresectable hepatocellular carcinoma are advancing, and there is an increasing amount of evidence regarding the use of combination therapies. Although there may be limitations on combinations in some regions, there is a growing need for research on multimodal treatments, which serve as the cornerstone of personalized medicine. Based on this evidence, we believe that effective combination therapies should be sought for each patient.