Stereotactic Body Radiation Therapy Combined With Immunotherapy for Patients With Hepatocellular Carcinoma-A Review

Radiotherapy has been proven to act synergistically with immunotherapy to prime the immune response against the immunosuppressive tumour microenvironment. Stereotactic body radiation therapy (SBRT) produces a greater variety of tumour-associated antigens. This can elicit an even stronger anti-tumour immune response, especially when combined with immune checkpoint inhibitors to prevent T cell exhaustion. This response is particularly useful in hepatocellular carcinoma patients due to a naturally immunosuppressive environment. SBRT has provided excellent local control rates in patients with hepatocellular carcinoma (HCC). Retrospective and prospective clinical trials involving advanced-stage HCC patients support combining SBRT with immune checkpoint inhibitors. Actively recruiting phase III randomised controlled trials are currently testing this promising combination in HCC patients. This mini-review outlines the rationale for combining the two modalities in HCC patients. Current guidelines for HCC and successes in the field using the combination treatment will also be discussed.