SITC Hepatocellular Carcinoma Immunotherapy Guideline

SITC's Cancer Immunotherapy Guidelines program is a collection of clinical practice guidelines (CPGs) developed by multi-disciplinary panels of experts who draw from their own practical experience as well as evidence in the published literature and clinical trial data to develop evidence- and consensus-based recommendations. SITC uses as a model the Institute of Medicine's 2011 "Standards for Developing Trustworthy Clinical Practice Guidelines" to ensure recommendations are unbiased, transparent, and balanced. 

The hepatocellular carcinoma guideline provides a valuable clinical decision-making tool to help guide oncologists and other advanced practice providers on topics including biomarkers, the selection of appropriate immunotherapeutic regimens, treatment response and monitoring, toxicity management, and patient quality of life considerations. 

Published Guideline

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Updated Content (last reviewed 5/3/24)
In accordance with the Institute of Medicine’s Standards for Developing Trustworthy Clinical Practice Guidelines, SITC CPGs undergo periodic evaluation to assess if new evidence necessitates modifications to recommendations, treatment algorithms, or other guideline content. This is done through our “SITC Living Guidelines” rapid update protocols designed to ensure SITC’s CPGs are up-to-date with cutting-edge thinking and incorporate the leading expert guidance in cancer immunotherapy care – a vital service to treating clinicians and those along the whole cancer care continuum. 

The information below provides an overview of updates made to the "Society for the Immunotherapy of Cancer (SITC) clinical practice guideline on immunotherapy for the treatment of hepatocellular carcinoma" published in Journal for ImmunoTherapy of Cancer (JITC).

Addendum v1.1 Summary

• On October 21, 2022, the United States Food and Drug Administration approved tremelimumab in combination with durvalumab for adult patients with unresectable HCC. Approval was based on statistically significant and clinically meaningful improvement in overall survival for tremelimumab plus durvalumab compared to sorafenib in the phase III HIMALAYA trial, which enrolled patients with confirmed unresectable HCC who had not received prior systemic treatment. In light of this approval, narrative text and recommendations within the guideline were updated via an addendum. Additionally, a new treatment algorithm was developed.
  
  

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Guideline Education

SITC is pleased to offer companion education resources in support of the published hepatocellular carcinoma CPG. These activities feature faculty comprised of the guideline expert panel and are designed to provide a deeper understanding of the recommendations in the SITC guidelines and how to apply them in various clinical scenarios.  The education available features one-hour webinars that take a deeper look at the guideline recommendations as well as mini-modules on a specific topic within the guideline content. Below is a list of the available educational resources for this CPG available free and on-demand. 

Webinars:

• Immunotherapy for the Treatment of Hepatocellular Carcinoma Guideline Overview- SITC CPG Webinar
  • Leading experts in cancer immunotherapy present an overview of the publication "The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of hepatocellular carcinoma."
    

• Practical Management Pearls for Immunotherapy for the Treatment of Hepatocellular Carcinoma- SITC CPG Webinar
  • This one hour on-demand webinar features members of the guideline Expert Panel. These faculty members discuss how to appraise and classify organ-specific considerations for immunotherapy agents and toxicities, identify and manage clinically significant uncommon toxicities, and determine optimal sequencing of immunotherapies in relapsed and/or refractory disease.

• Case Studies in Immunotherapy for the Treatment of Hepatocellular Carcinoma- SITC CPG Webinar
  • This one hour on-demand webinar features members of the guideline Expert Panel. These faculty members discuss case studies that illustrate execution of SITC guideline recommendations, as well as discussion on difficult topics related to case management. 

Mini-Modules:

• Front-Line Management for Advanced HCC
  • Features a case study on the use of atezolizumab and bevacizumab to treat advanced hepatocellular carcinoma (HCC). Results from the IMbrave 150 clinical trial, immune-related adverse effects, and HCC treatment sequencing options are also presented. Ends with a panel discussion of important considerations when choosing first-line treatment of HCC.

• IO-IO Therapy in Second-Line Treatment
  • Features a case study on the use of nivolumab and ipilumumab as second-line treatment of advanced HCC. Discusses results from the CheckMate 040 clinical trial that led to FDA approval of this IO-IO therapy, management of immune-mediated adverse effects, and current knowledge gaps in the second-line treatment of HCC. Concludes with a panel discussion on discontinuing immunotherapy in patients who respond to treatment.

• Immunotherapy for HCC with Child-Pugh B Cirrhosis
  • Features a case study on immunotherapy of HCC in a patient with alcoholic liver cirrhosis. Discusses the relationship between liver function and patient outcomes during HCC treatment using data from the GIDEON study and the CheckMate 040 clinical trial. Includes a Q&A session focused on using immunotherapy in combination with other local-regional therapies to treat HCC, treating HCC in special patient populations, and the changing landscape of immunotherapy and HCC.

For questions regarding SITC CPGs, please contact a member of the Scientific Publications Department at scientificresources@sitcancer.org.