In this short newsletter, the ILCA Communications Committee highlighted a selection of studies on primary liver cancer presented during the EASL Digital International Liver Congress ILC2020.

Regorafenib for recurrent HCC after liver transplantation: a real-life experience
This multicentric retrospective study compared the outcomes of patients with recurrent HCC after liver transplantation treated either by regorafenib or best supportive care. 32 patients received regorafenib and were compared with 64 patients receiving best supportive care and the two groups were adjusted using a propensity matching analysis. The most frequent adverse events in the regorafenib arm were fatigue and hand foot syndrome. After adjustment, patients treated by regorafenib had a longer median overall survival (14 months) compared to patients treated by best supportive care (4.5 months, P<0.0005).
Regorafenib improves survival after sorafenib treatment in patients with recurrent HCC after liver transplantation, compared to best supportive care
Iavarone M, et al. DILC 2020; AS150

Radiofrequency ablation versus proton beam therapy for HCC treatment: a randomized controlled phase 3 non-inferiority trial
This multicentric randomized controlled trial compared percutaneous radiofrequency ablation with external proton beam therapy for the treatment of small HCC classified BCLC O or A (< 3 cm and less than 3 HCC). The study was designed as a non-inferiority randomized clinical trial. 72 patients received monopolar radiofrequency ablation and 72 received external proton beam therapy. Intention to treat analysis reached the criteria for the non-inferiority in term of local progression free survival between the two arms (92.8% of local progression free survival in the external proton beam therapy arm versus 82.2% in the RFAA arm).
PBT versus RFA treatment in patients with rHCC: a randomized controlled phase 3 non-inferiority APROH trial
Park J-W, et al. DILC 2020; LBO07

Liquid biopsy in advanced HCC: a predictive biomarker?
This prospective study has analyzed mutations in circulating tumor DNA in 121 patients with advanced HCC. The most frequent mutations detectable were TERT promoter mutations (51%), TP53 mutations (32%), CTNNB1 mutations (17%) and PTEN mutations (8%). In contrast with previous data published in the literature, mutations in the Wnt/B-catenin pathway were not associated with resistance to immunotherapy. Patients with detectable circulating mutations in PI3K/Mtor pathway had a shorter progression free survival (P=0.01) when treated with tyrosine kinase inhibitors.
Mutations in circulating tumor DNA predict primary resistance to systemic therapies in patients with advanced hepatocellular carcinoma
Von Felden J, et al. DILC 2020; SAT490

SPEAR T cell for the treatment of hepatocellular carcinoma: a pilot study
ADP-A2AFP SPEAR T cells are genetically modified T cell that aims to destroy cancer cell by targeting AFP. SPEAR T cells were injected after lymphodepletion using cyclophosphamide in 9 patients with HCC expressing AFP in the tumor (divided in 3 groups with different doses). The main adverse events were lymphopenia and neutropenia. Radiological response was observed in 2 of the 4 patients treated with the highest dose of cyclophosphamide and the highest number of SPEAR T cells injected.
Data from the third dose cohort of an ongoing study with ADP-A2AFP SPEAR T cells
Bruno Sangro, et al. DILC 2020 ; LBO12

Immune related adverse events and outcomes under immunotherapy in patients with HCC
361 patents treated by immunotherapy (mainly anti PD(L)1 antibody) for hepatocellular carcinoma were analyzed. 21% of patients had a treatment related adverse events grade 2 or more. Presence of treatment related adverse events was associated with a longer progression free survival and overall survival. It was also associated with a higher rate of overall response rate (13.9% vs 26.3%, P=0.01).
Treatment-related toxicity predicts for improved outcome in patients with hepatocellular carcinoma (HCC) treated with immune checkpoint inhibitor therapy.
David J. Pinato, et al. DILC 2020 ; AS054

Thank you to the ILCA Communications Committee for providing the content and working to advance liver cancer science.