A Post-International Gastrointestinal Cancers’ Conference (IGICC) Position Statements

Figures & data

Table 1 The Grading for Liver Fibrosis According to Ishak (Modified Knodell) Scoring System

Finding	Score	Reference
No fibrosis	0	[10,11]
Fibrous expansion of some portal areas, with or without short fibrous septa	1
Fibrous expansion of most portal areas, with or without short fibrous septa	2
Fibrous expansion of most portal areas, with occasional portal to portal bridging	3
Fibrous expansion of portal areas with marked bridging (portal to portal) as well as portal to central	4
Marked bridging (portal to portal and/or portal to central) with occasional nodules (incomplete cirrhosis)	5
Cirrhosis, probable or definite	6

Table 2 Liver Imaging Reporting and Data System (LI-RADS) Categorises the HCC Risk in Screened Patients

Category	Assessment	Reference
LR-1	Definitely benign	[19]
LR-2	Probably benign
LR-3	Intermediate probability of malignancy
LR-4	Probably HCC
LR-5	Definitely HCC
LR-M	Probably or definitely malignant, not specific for HCC
LR-NC	Not categorizable
LR-TIV	Tumor in vein

Abbreviations: LR, LI-RADS; TIV, Tumor in vein; NC, not categorizable; HCC, hepatocellular cancer; M, malignant.

Table 3 A Summary of Practice-Changing Clinical Studies That Shaped Our Current First-Line Treatments for Advanced/Metastatic Hepatocellular Cancer

Trial	Line	Agent	Phase	Patient Number	ORR (RECIST 1.1)	mPFS Months	mOS Months	Reference
Sharp	First-line	Sorafenib vs Placebo	III	299 vs 303	2% vs 1%	5,5 vs 2.8	10,7 vs 7.9	[95]
Asia-Pacific	First-line	Sorafenib vs Placebo	III	150 vs 76	???	2,8 vs 1.4	6,5 vs 4.2	[96]
REFLECT	First-line	Lenvatinib vs Sorafenib	III	478 vs 476	19% vs 7%	7,3 vs 3.6	13,6 vs 12.3	[97]
HIMALAYA	First-line	STRIDE vs Durvalumab Vs Sorafenib	III	393 vs 389 vs 389	20% vs 17% vs 5%	3,8 vs 3.7 vs 4.1	16,4 vs 16.6 vs 13.8	[102]
IMbrave150	First-line	Atezolizumab plus Bevacizumab vs Sorafenib	III	336 vs 165	30% vs 11%	6,9 vs 4.3	19,2 vs 13.4	[105]
COSMIC-312	First-line	Atezolizumab plus Cabozantinib vs Sorafenib	III	432 vs 217	11% vs 4%	6,8 vs 4.2	15,4 vs 15.5	[106]
LEAP-002	First-line	Lenvatinib plus pembrolizumab vs Lenvatinib	III	395 vs 399	26,1% vs 17.5%	8,2 vs 8.0	21,2 vs 19.0	[108]
CheckMate 459	First-line	Nivolumab vs Sorafenib	III	371 vs 372	15% vs 7%	3,7 vs 3.8	16,4 vs 14.7	[109]
NCT03764293	First-line	Camrelizumab plus rivoceranib vs Sorafenib	III	272 vs 271	25,4% vs 5.9%	5,5 vs 3.7	22,1 vs 15.2	[110]

Abbreviations: N.A, not applicable; ORR, objective response rate; mOS, mean overall survival; mPFS, mean progression free survival.

Table 4 A Summary of Practice-Changing Clinical Studies That Shaped Our Current Second-Line Treatments for Advanced/Metastatic Hepatocellular Cancer

Trial	Line	Agent	Phase	Patient Number	ORR (RECIST 1.1)	mPFS Months	mOS Months	Reference
REACH	Second line	Ramucirumab vs Placebo	III	283 vs 282	7% vs <1%	2,8 vs 2.1	9,2 vs 7.6	[98]
REACH-2	Second line	Ramucirumab vs Placebo	III	197 vs 95	5% vs 1%	2,8 vs 1.5	8,1 vs 5.3	[99]
RESORCE	Second line	Regorafenib vs Placebo	III	379 vs 194	7% vs 3%	3,1 vs 1.5	10,6 vs 7.8	[113]
CELESTIAL	Second line	Cabozantinib vs Placebo	III	470 vs 237	4% vs <1%	5,2 vs 1.9	10,2 vs 8.0	[115]
CheckMate 040	Second line	Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg	I/II	50	32%	NA	22,5	[116]
CheckMate 040	Second line	Nivolumab 3mg/kg, dose expansion cohort	I/II	214	20%	NA	NA	[116]
KEYNOTE-240	Second line	Pembrolizumab vs Placebo	III	178 vs 135	18,3% vs 6.4%	3,0 vs 2.8	13,9 vs 10.6	[118]

Abbreviations: N.A, not applicable; ORR, objective response rate; mOS, mean overall survival; mPFS, mean progression free survival.

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