Page 27 - Read Online

Mathias-Machado et al. Hepatoma Res 2021;7:67 Hepatoma Research
DOI: 10.20517/2394-5079.2021.84

Perspective Open Access

Neoadjuvant and adjuvant systemic treatment for

hepatocellular carcinoma

Maria Cecilia Mathias-Machado, Leonardo G. da Fonseca
Clinical Oncology, Instituto do Cancer do Estado de Sao Paulo, University of Sao Paulo, São Paulo 01246-000, Brazil.

Correspondence to: Dr. Leonardo G. da Fonseca, São Paulo Clínicas Liver Cancer Group - Hospital das Clínicas Complex,
Instituto do Cancer do Estado de São Paulo, University of São Paulo School of Medicine. Av Dr. Arnaldo, 450, São Paulo 01246-
000, Brazil. E-mail: l.fonseca@fm.usp.br

How to cite this article: Mathias-Machado MC, da Fonseca LG. Neoadjuvant and adjuvant systemic treatment for hepatocellular
carcinoma. Hepatoma Res 2021;7:67. https://dx.doi.org/10.20517/2394-5079.2021.84
Received: 25 Jun 2021 First Decision: 4 Aug 2021 Revised: 9 Aug 2021 Accepted: 23 Aug 2021 Published: 15 Oct 2021

Academic Editors: James Fung, Allan Tsung Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Hepatocellular carcinoma (HCC) is a highly lethal malignancy, and few patients are candidates for curative-
intended therapies. The mainstay of curative treatment in HCC is surgical resection, ablation, and transplantation.
However, rates of recurrence are high, and there is no established approach to reduce the risk of recurrence and
mortality. We discuss the available data and current landscape of (neo)adjuvant therapies aimed at decreasing
recurrence risk and improving overall survival, including liver-directed therapies, tyrosine kinase inhibitors, and
immunotherapy. Neoadjuvant strategies aimed at downstaging advanced HCC to enable local treatment and
minimize the risk of recurrence using novel agents are also a topic of interest in current research. The
improvements achieved in the advanced stages with immune-checkpoint inhibitors are priming ongoing trials that
address potential future directions for both adjuvant and neoadjuvant strategies that may change the treatment
paradigm of HCC in the near future.

Keywords: Liver neoplasm, hepatocellular carcinoma, neoadjuvant treatment, adjuvant treatment, immunotherapy

INTRODUCTION
Hepatocellular carcinoma (HCC) is a highly fatal disease, although several strategies for early diagnosis and
management have emerged in recent years. Clinical treatment approaches are challenging due to the
concomitance of HCC with cirrhosis complications and the fact that many patients are diagnosed at an

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.hrjournal.net