Single-center retrospective study of impact of neoadjuvant immunotherapy on recurrence-free survival among patients with high-risk localized hepatocellular carcinoma

Surgical resection for localized hepatocellular carcinoma (HCC) is typically reserved for a minority of patients with favorable tumor features and anatomy. Neoadjuvant immunotherapy might expand the number of patients who are candidates for surgical resection. A retrospective cohort study at Johns Hopkins Hospital (Baltimore, MD) compared outcomes of patients receiving neoadjuvant ICI-based immunotherapy to outcomes of patients undergoing upfront resection. The majority (61.1%) of the patients receiving neoadjuvant immunotherapy were outside of standard resectability criteria and were more likely to have features known to confer risk of disease recurrence, including AFP ≥ 400 ng/ml, tumor diameter ≥ 5 cm, portal vein invasion, and multifocality. Patients receiving neoadjuvant immunotherapy had similar rate of margin-negative resection (94.4%) as those undergoing upfront resection. The median recurrence-free survival was 44.8 months, compared with 49.3 months among those undergoing upfront resection. There was a nonsignificant trend of superior RFS in the subset of patients with pathologic response to neoadjuvant immunotherapy. The authors conclude that neoadjuvant ICI-based immunotherapy may allow high-risk patients, including those who are outside traditional resectability criteria, to achieve comparable clinical outcomes to those who undergo upfront resection.