Treatment Strategy for Intermediate-Stage Hepatocellular Carcinoma: Transarterial Chemoembolization, Systemic Therapy, and Conversion Therapy

SIMPLE SUMMARY: Systemic therapy for advanced-stage hepatocellular carcinoma (HCC) is undergoing major changes owing to the advancements made in molecular-targeted therapies and immune checkpoint inhibitors (ICIs). Although transarterial chemoembolization has been used as the standard treatment for intermediate-stage HCC, it has recently included molecular-targeted drugs and ICIs. As intermediate-stage HCC encompasses a wide variety of HCCs, the appropriate regimen to be used and the order of drug administration, including the use of anti-angiogenic inhibitors, remain controversial. This review discusses treatment strategies for intermediate-stage HCC considering the background of progress in the treatment of advanced-stage HCC. ABSTRACT: Transarterial chemoembolization (TACE) has been standard treatment for intermediate-stage hepatocellular carcinoma (HCC). However, all intermediate-stage HCC patients did not benefit from TACE treatment because intermediate-stage HCC encompasses a wide variety of HCCs. Owing to remarkable progress in systemic therapy, including molecular-targeted therapy for advanced-stage HCC, the standard treatment of HCC has recently shifted to systemic therapy. However, it remains controversial as to which treatment should be initially performed for intermediate-stage HCC. In addition, although curative treatment can be considered when the tumor shrinks, the timing of conversion therapy remains uncertain. This review summarizes the advances of HCC treatment and discusses treatment strategies for intermediate-stage HCC.