185 Neoadjuvant immunotherapy in Advanced Hepatocellular Carcinoma: A Promising approach towards Curative Intent treatment?

Abstract Background Immunotherapy has shown promise in advanced HCC. It is of interest to know whether this approach can be applied in the neoadjuvant setting. Aims To evaluate the therapeutic outcomes of neoadjuvant immunotherapy in advanced HCC Methods Patients (n=15) with BCLC C HCC, unsuitable for surgery but suitable for Immunotherapy underwent a minimum of 3 cycles of Atezolizumab–Bevacizumab over the past 1 year. The response was assessed by Triple phase contrast CT along with a PET scan, AFP and PIVKA II at the end of 3 months. Response dictated 6 cycles of therapy, while progression or grade III/IV adverse events led to cessation. Further bridging/downstaging liver-directed therapy was offered if being considered for LT. Results Three patients developed progressive disease while on Immunotherapy. N=2 underwent Liver transplantation and n=1 underwent resection, n=4 are still undergoing Immunotherapy. The remaining 5 were not considered for curative therapy due to various reasons. The 3 patients who underwent curative surgery have a median recurrence-free survival of 6 months (range 4 - 14 months). They are being followed up intensively. Profiling of the 3 surgical specimens demonstrated enrichment of tumour infiltrating lymphocytes (TILs) and stromal lymphocytes, with CD8>CD4, also CD3>CD20 lymphocytes signifying the role of B lymphocytes in local immune activation and antitumor activity. Conclusion Neoadjuvant immunotherapy may provide a novel downstaging strategy in select patients with advanced HCC with curative intent. Further studies are needed to validate this approach and guide in sequencing systemic and local therapies towards this goal.