Durvalumab with tremelimumab for untreated advanced or unresectable hepatocellular carcinoma [ID2725]

Hepatocellular carcinoma (HCC) is the most common form of liver cancer in England accounting for 65% of primary liver cancer diagnoses in men and 34% of diagnoses in women in 2021.(1) It is commonly associated with liver cirrhosis (scarring of the liver) which can be caused by viral infections such as hepatitis B or C excessive alcohol intake or other diseases that result in chronic inflammation of the liver.(1) There were a total of 3021 new diagnoses of HCC in England in 2021.

Of these 2362 were in men and 659 in women.(1)The most common staging system is the Barcelona Clinic Liver Cancer (BCLC) system.

The Child–Pugh assessment of liver impairment and Eastern Cooperative Oncology Group [ECOG] performance score are used to assign BCLC stage.

The stage at which HCC is detected has a significant impact on survival; people with advanced HCC have a poorer prognosis than people with early stage HCC.(2)Treatment for HCC depends on the location and stage of the cancer and how well the liver function is preserved. For people with more advanced disease treatment is palliative rather than curative.

Treatment options include interventional procedures such as transarterial bland embolisation transarterial chemoembolisation (using doxorubicin or cisplatin) or selective internal radiation therapy (SIRT) and external beam radiotherapy.(2) For unresectable advanced HCC only in adults with Child-Pugh grade A liver impairment and when conventional transarterial therapies are inappropriate NICE technology appraisal guidance 688 recommends SIR-Spheres and TheraSphere.Systemic therapy can be given if the condition is refractory to locoregional therapy or when these therapies are not suitable because of the extent of cancer within the liver or metastatic disease.

NICE recommends the following first-line systemic treatment options:• sorafenib for treating advanced HCC only for people with Child-Pugh grade A liver impairment (NICE technology appraisal guidance 474)• lenvatinib for untreated advanced unresectable HCC in adults with ChildPugh grade A liver impairment and an ECOG performance status of 0 or 1 (NICE technology appraisal guidance 551)• atezolizumab plus bevacizumab for treating advanced or unresectable HCC in adults who have not had previous systemic treatment and only if they have Child-Pugh grade A liver impairment and an ECOG performance status of 0 or 1 (NICE technology appraisal guidance 666).Best supportive care is offered to people who choose not to have or cannot have systemic therapy or if their disease does not respond to systemic therapy.References1.

NHS Digital (2023) Cancer Registrations Statistics England 2021- First release counts only. Accessed June 2024.2.

Suddle A Reeves H Hubner R et al. (2024) British Society of Gastroenterology guidelines for the management of hepatocellular carcinoma in adults. Gut published online first doi: 10.1136/gutjnl-2023-331695. Accessed June 2024.