Timing Systemic Therapy and Locoregional Treatment in Intermediate-Stage HCC

The panel discusses the timing of systemic therapy alongside locoregional treatment in intermediate-stage hepatocellular carcinoma (HCC), focusing on the EMERALD-1 results. The experts weigh whether the progression-free survival benefit of adding durvalumab and bevacizumab to transarterial chemoembolization (TACE) justifies earlier systemic therapy, given that overall survival data are not yet mature. Several panelists note that historically a hazard ratio below 0.7 for progression-free survival has correlated with an overall survival benefit, and they discuss how the EMERALD-1 hazard ratio leaves the question open. They emphasize multidisciplinary review, patient selection, and risk-benefit conversations, particularly for younger patients with bulky or multifocal disease who may not get a second chance at systemic therapy. The discussion also addresses whether yttrium-90 radioembolization could replace TACE in centers that favor it, with the experts agreeing that ongoing trials, including the EMERALD yttrium-90 study, are needed to clarify optimal sequencing in advanced HCC.