Researchers have made a major breakthrough in liver cancer treatments by finding that an interval of 50 days or more between the end of immunotherapy treatment and receiving a liver organ transplant reduces significantly the chance of rejection. The discovery gives hope to those who are battling the most common type of liver cancer, hepatocellular carcinoma (HCC).
This international study, led by University Hospitals of Geneva and University of Geneva, could result in safer and more effective treatments for advanced HCC patients. These findings have been hailed as an important step in reconciling the two approaches that can save lives: liver transplantation and immunotherapy.
Hepatocellular cancer accounts for between 80-90% primary liver tumors worldwide. In 2020, there will be over 830,000 new cases of HCC and nearly 906,000 deaths. The gold standard in treating HCC is liver transplantation, which can offer a cure through the replacement of the affected organ.
Immunotherapy has also shown impressive results, particularly immune checkpoint inhibitors. In some cases, the tumors were completely remitted.
Combining these two treatments poses a problem. While ICI stimulates the immune response to attack cancerous cells it can also increase the likelihood of the immune cells attacking the transplanted organ. The increased risk of graft-rejection has been a barrier to the use of these treatments.
This study from Geneva, which analysed data of 119 patients in 29 hospitals around the world, offers critical insight into minimising these risks. Researchers discovered timing was everything.
A time interval less than 30 days from the final immunotherapy to the liver transplant can increase the risk of rejection by more than 21 times. The risk is reduced by extending the time interval from 30-50 days, but the rate of rejection only drops significantly after 50 days.
Early detection device for organ rejection
Our research shows that the 50-day mark is ideal. Christian Toso is the Head of Abdominal Surgery and a Professor at UNIGE. If you wait any longer than that, the cancer could progress.
These findings have implications that go beyond the realm of academia. The study identifies the optimal time interval for immunotherapy to be integrated into liver transplantation protocol, giving patients the chance of remission or even cure.
This breakthrough brings together two leading-edge treatments, which could potentially save many lives. Beat Moeckli is a Senior Resident and first author in abdominal surgery at HUG. We hope that this research soon leads to guidelines to help expand liver transplantation and improve patient outcomes.
HUG, leveraging decades of experience in liver transplantation research, is poised for global leadership in this rapidly evolving field. The advancements will reduce the risk of rejection, improve patient selection criteria and refine transplant techniques in cancerous cases.
The development is a major turning point for the battle against liver cancer. It signals a new era in which patients will be able to benefit from a combination of immunotherapy with transplantation.
Journal Reference
- Moecli Beat, Wassmer, Charles-Henri, et al. A retrospective international cohort study determined the safe washout time for immune checkpoint inhibitors before liver transplantation. Hepatology . DOI: 10.1097/HEP.0000000000001289
