Liver cancer experts at 17 cancer centers, part of a consortium of North American experts called HCC-LIVE, have compiled a guidance on the best treatments for hepatocellular carcinoma in North America.
The resource, called BEACON-HCC, was published in the journal Hepatology.
BEACON-HCC spells out treatment recommendations, supported by data from the medical literature, for each stage of HCC.
It incorporates the degree of tumor burden, invasion into the vascular system, tumor biology, and more to align treatment allocation with the practices of HCC experts in North America.
BEACON-HCC incorporates emerging modalities, such as external beam radiation therapy, a treatment that uses high energy beams of radiation to shrink or destroy cancer cells; transarterial radioembolization, a minimally invasive therapy that delivers radioactive beads directly into the blood vessels feeding a tumor; and novel combination therapies that work throughout the body and specifically target the tumors.
For nearly 30 years, clinicians around the world have relied on the Barcelona Clinic Liver Cancer staging and treatment allocation system, said Mark Yarchoan, BEACON-HCC co-author and an associate professor of oncology at the Johns Hopkins University School of Medicine. However, the treatment landscape for HCC has changed dramatically, necessitating new systems.
“The BCLC does not elevate all of the treatment paradigms that we have available to us, and promotes treatment decisions that are somewhat different from how we have practiced at our institution,” Yarchoan said in a statement.
“HCC management is a complex multidisciplinary effort due to disease biology and the variety of treatment options,” Jeffrey Meyer, co-author and an associate professor of radiation oncology and molecular radiation sciences at the Johns Hopkins University School of Medicine, said in a statement. “We wanted to lay out these issues and marshal together different approaches for each stage of the disease, reflecting our practices at Johns Hopkins and other centers.”
The idea for BEACON-HCC arose as Yarchoan, Meyer, and colleagues at Johns Hopkins recognized that their management of patients with HCC was increasingly diverging from the BCLC recommendations.
“For example, BCLC classifies tumors that invade the blood vessels as advanced disease and recommends systemic therapy alone,” Yarchoan said. “But in the modern treatment era, vascular invasion does not necessarily mean that remission is out of reach. In a prospective clinical trial at Johns Hopkins, we showed that selected patients with vascular invasion could still undergo potentially curative resection.”
Meyer points to radiation as another example. Earlier versions of the BCLC did not recognize radiation as a major treatment option, but high-level clinical trial data now show that it can play “a very meaningful role” in HCC management, he says, either as the primary treatment or in combination with other therapies.
The team began reaching out to other experts in the U.S. who were making similar observations and decided to write its own guidance, a process that took nearly two years.
The 20 co-authors validated BEACON-HCC in two ways.
First, they pulled 29 de-identified patient cases from their institutions. Each submission included brief clinical information and tumor imaging. All co-authors independently reviewed each case and selected their recommended initial treatment approach from options such as surgical resection, liver transplantation and other therapies. They also shared the same cases with 18 North American HCC clinical experts who were not involved in the development of BEACON-HCC to get their feedback on the best course of treatment. Then, they compared the percentage of agreement of both groups with BEACON-HCC recommendations and BCLC 2025 treatment recommendations. The experts’ treatment decisions were 96.6% in alignment with the BEACON-HCC recommendations but only 72.4% in agreement with the BCLC recommendations.
“Our hope was to explain to the broader community how we currently manage HCC in our own multidisciplinary clinic,” Yarchoan said. “Hopefully, it can influence the way that people think about this cancer.”
HCC is the third-leading cause of cancer-related death worldwide and the leading cause of cancer-related death in patients with cirrhosis. The five-year survival for HCC remains below 25% despite improvements in screening and treatment.
BEACON-HCC provides a framework to consider each patient at their stage and appreciate all of the different treatment options that are available.
“It summarizes what we have available but also recognizes some of the outstanding questions for patients,” Meyer said. “I think it will help provide a good framework for tumor board and multidisciplinary clinic discussions.”
“As systemic and locoregional therapies continue to evolve, BEACON-HCC provides a dynamic, adaptable framework that can grow alongside our expanding therapeutic armamentarium for HCC,” Marina Baretti, an assistant professor of oncology and the Jiasheng Chair in Hepato-Biliary Cancer Research at the Johns Hopkins University School of Medicine, said in a statement. “What excites me most about BEACON-HCC is that it reflects the reality of multidisciplinary HCC care: No single factor determines treatment, and a classification system should reflect that complexity, while remaining practical and clinically actionable.”
Baretti, co-director of the Liver and Biliary Cancer Multidisciplinary Clinic at the Kimmel Cancer Center, was one of the experts who helped validate the tool.
