Combining locoregional treatments and immunotherapies in patients with unresectable hepatocellular carcinoma
Cette étude passe en revue les données cliniques justifiant, pour un carcinome hépatocellulaire non résécable, le recours aux traitements combinant des inhibiteurs de point de contrôle immunitaire et des traitements localisés comme la chimio-embolisation transartérielle, la radio-embolisation transartérielle ou la radiothérapie externe
The systemic treatment landscape of unresectable hepatocellular carcinoma has been transformed by immune-checkpoint inhibitor (ICI)-based regimens. These advances have led to efforts to combine ICIs with locoregional therapies (LRTs), particularly transarterial chemoembolization, transarterial radioembolization and external beam radiotherapy, in an attempt to improve tumour control and extend the benefits of ICIs to patients with intermediate-stage disease. The rationale for this combination approach is provided by the ability of LRTs to induce immunogenic cell death and tumour antigen release and to reprogramme the immunosuppressive tumour microenvironment. Five phase III trials have thus far shown improvements in progression-free survival and objective response rates with regimens combining ICIs with transarterial chemoembolization. Early-phase and real-world data also support the combination of ICIs with transarterial radioembolization or external beam radiotherapy, particularly in selected patients with focal disease unsuitable for embolization or portal vein tumour thrombosis. However, various challenges remain, including patient selection and therapy sequencing, response assessment, and the growing difficulties in demonstrating survival advantages in the context of widespread post-progression crossover and effective subsequent therapies. In this Review, we describe the biological rationale, summarize the clinical evidence and discuss future directions for trial design, imaging and biomarker-driven patient selection in the integration of LRTs with immune-based regimens for patients with unresectable hepatocellular carcinoma.
Nature Reviews Clinical Oncology , résumé, 2026