Neoadjuvant immunotherapy in HCC: recurrence patterns and treatment sequencing

Neoadjuvant immune checkpoint inhibition prior to liver resection remains investigational in early hepatocellular carcinoma (HCC). While early-phase trials have demonstrated feasibility, data on long-term outcomes and on optimal treatment sequencing after recurrence have been lacking. This patient-level pooled analysis of phase I/II trials, conducted through the global NeoHCC consortium, included 141 patients with early-stage, resectable HCC (predominantly BCLC 0-A) who received neoadjuvant immune checkpoint inhibition before planned resection.¹

Neoadjuvant immunotherapy was feasible and induced tumour responses, with an objective response rate of 22.7%, a disease control rate of 91% and a low drop-out rate before resection (4%). A major pathological response was observed in 26% of patients.

At a median follow-up of 43 months, recurrence occurred in 37% of patients. Early recurrence, within 12 months after surgery, remained an important challenge and was associated with significantly worse survival compared with late or no recurrence. Most recurrences occurred within the liver, and the majority of patients were eligible for further anticancer treatment, particularly locoregional therapies. Patients with extrahepatic disease more often required systemic treatment and had poorer outcomes. These findings support the feasibility and antitumour activity of neoadjuvant immunotherapy in HCC, while highlighting early recurrence as a key unmet need.