Dr Iglesia on the Potential Role for Disease Etiology in Frontline HCC Treatment Selection

Michael Iglesia, MD, PhD, instructor, John T. Milliken Department of Medicine, Division of Oncology, Washington University School of Medicine, discusses the potential role of disease etiology in frontline hepatocellular carcinoma (HCC) treatment decision-making.

The role of disease etiology in frontline HCC treatment selection has been previously investigated, which the majority of prior research comparing viral vs nonviral causes of liver disease, Iglesia begins. Viral etiology mainly comprises long-term infection with hepatitis B or C virus; nonviral forms of HCC include alcoholic liver disease, autoimmune disease, and metabolic disease. Insights into this topic primarily come from global studies, where viral etiologies are more prevalent compared with the US, where nonviral etiology is more common, Iglesia states.

Immune checkpoint inhibitors are currently a standard-of-care therapy for patients with unresectable HCC in the frontline. However, many of these patients will not achieve a response with these agents, with approximately 20% to 40% of patients experiencing primary resistance to these regimens. Current evidence has implicated nonviral HCC in the development of resistance to checkpoint inhibitors. In contrast, patients who develop HCC due to viral infections may experience additional benefits from treatment with checkpoint inhibition, Iglesia details.

Iglesia states that this preference does not significantly influence his own clinical practice at present; however, it may become a more critical factor in the future. He speculates that future treatment strategies may be stratified based on the underlying etiology of the disease, allowing for more personalized and effective therapeutic approaches.

Although knowledge of the underlying cause of HCC does not currently have a substantial impact on treatment decisions in the frontline setting, ongoing research and clinical trials might soon provide more definitive guidance on tailoring therapies to the specific etiologies of HCC, potentially improving outcomes for different patient populations, Iglesia concludes.