Guideline reviews perioperative immunotherapy for hepatocellular carcinoma after resection or ablation

A guideline reviews evidence on perioperative immunotherapy strategies—including adjuvant, neoadjuvant, and biomarker-guided approaches—for patients with hepatocellular carcinoma after resection or ablation. The guideline notes that adjuvant atezolizumab plus bevacizumab initially improved recurrence-free survival in the IMbrave050 trial, but this effect attenuated with longer follow-up. Additionally, adjuvant single-agent checkpoint inhibitor programs have not demonstrated consistent benefit, and camrelizumab plus rivoceranib showed improved event-free survival, though specific effect sizes and absolute numbers were not reported.

Safety and tolerability data for these perioperative regimens were not reported in the guideline summary. Key limitations highlighted include that the benefit of perioperative immunotherapy is not universal across all patients or regimens, and the observed attenuation of effect with longer follow-up in IMbrave050 raises questions about durability.

The guideline suggests that future optimization of perioperative immunotherapy will likely depend on biomarker-driven patient selection, including the use of circulating tumor DNA for minimal residual disease detection, assessment of resistance-associated alterations, and consideration of etiology-linked immune phenotypes. These factors may help identify which patients are most likely to benefit from specific treatment sequences. The evidence remains evolving, and clinicians should interpret these findings cautiously given the variability in outcomes reported.