Sequential TACE and SBRT followed by immunotherapy for conversion of locally advanced, unresectable hepatocellular carcinoma

Synergy between locoregional therapies and immune checkpoint inhibition has not been investigated as conversion therapy for unresectable hepatocellular carcinoma (uHCC). The phase 2 START-FIT trial, at two centers in Hong Kong and one in Shenzhen, evaluated sequential transarterial chemoembolisation (TACE) and stereotactic body radiotherapy (SBRT) followed by avelumab (anti-PD-L1) for patients with locally advanced uHCC who were not candidates for curative treatment. After TACE, SBRT, and avelumab 55% of patients were deemed amenable to curative treatment.