Ep. 659 Combination Therapy for Hepatocellular Carcinoma with Dr. Beau Toskich and Dr. Lingling Du

How do you safely combine locoregional and systemic therapies to treat hepatocellular carcinoma (HCC) when traditional guidelines suggest your hands are tied? In this episode of the 2026 HCC Creator Weekend™, medical oncologist Dr. Lingling Du (Ochsner Health) and interventional radiologist Dr. Beau Toskich (Mayo Clinic Florida) join Dr. Tyler Sandow to break down patient selection, timing strategies, and the practical application of clinical trial outcomes when integrating Y90 radioembolization and immunotherapy in HCC management. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by an educational grant from Sirtex and Boston Scientific. --- Timestamps 00:00 - Introduction01:48 - Two HCC Cases03:31 - Disease Progression on Combination Therapy07:05 - Alternatives After Immunotherapy Failure09:09 - Salvage with Ablative Y9013:41 - Mechanism of Immunotherapy15:43 - EMERALD-1 and LEAP-01220:52 - Adverse Events with Combination Therapy27:21 - Treatment Timing and Sequencing28:48 - Case: Borderline BCLC B33:48 - Case: BCLC C with Portal Vein Thrombus37:06 - Raising the Survival Tail40:11 - Final Thoughts and Closing Remarks --- More about this episode The physicians highlight how selective local treatment can achieve complete responses and salvage cases with aggressive disease. They emphasize that treatment based on anatomical and biological phenotype may yield better results than strictly adhering to rigid staging categories, while acknowledging the challenges of managing microscopic disease and unpredictable long-term tumor behavior. Dr. Du and Dr. Toskich also note that selecting the right combination regimens requires balancing aggressive tumor kinetics against the patient’s baseline liver function, pointing out that well-tolerated regimens like STRIDE are often easier to pair with Y90 than checkpoint or VEGFR inhibitors that alter tumor blood flow. While recent TACE-immunotherapy trials (EMERALD-1 and LEAP-012) may be confounded by patient heterogeneity, the physicians observe that a distinct subset of patients achieves durable, long-term remission, effectively raising the survival tail for an otherwise incurable population. Ultimately, they conclude that cross-specialty education and leaning into the expert intuition of a multidisciplinary team are essential for securing the best outcomes for patients with intermediate and advanced HCC. --- Resources Study of Durvalumab and Tremelimumab as First-line Treatment in Patients With Advanced Hepatocellular Carcinoma (HIMALAYA)https://clinicaltrials.gov/study/NCT03298451 A Study of Atezolizumab in Combination With Bevacizumab Compared With Sorafenib in Patients With Untreated Locally Advanced or Metastatic Hepatocellular Carcinoma (IMbrave150)https://clinicaltrials.gov/study/NCT03434379 Nivolumab plus ipilimumab versus lenvatinib or sorafenib as first-line treatment for unresectable hepatocellular carcinoma (CheckMate 9DW): an open-label, randomised, phase 3 trialhttps://doi.org/10.1016/S0140-6736(25)00403-9 Durvalumab with or without bevacizumab with transarterial chemoembolisation in hepatocellular carcinoma (EMERALD-1): a multiregional, randomised, double-blind, placebo-controlled, phase 3 studyhttps://doi.org/10.1016/S0140-6736(24)02551-0 Transarterial chemoembolisation combined with lenvatinib plus pembrolizumab versus dual placebo for unresectable, non-metastatic hepatocellular carcinoma (LEAP-012): a multicentre, randomised, double-blind, phase 3 studyhttps://doi.org/10.1016/S0140-6736(24)02575-3 --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app