Breakthroughs, Reality Checks, and New Directions in HBP Cancer Care
This year, among the many research outcomes presented at ASCO GI, four studies concerning Hepatocellular Carcinoma (HCC), Advanced Cholangiocarcinoma (CCA), and Oligometastatic Disease (OMD) were discussed in the context of Hepato-Bilio-Pancreatic (HBP) Cancers.
- ABC-HCC for intermediate stage Hepatocellular Carcinoma
This phase III study evaluated the efficacy of Atezolizumab plus Bevacizumab (an immunotherapy/anti-angiogenic combination) compared with TACE (Transarterial Chemoembolization), the current standard of care for local treatment in patients with intermediate-stage Hepatocellular Carcinoma (HCC). It specifically included patients with disease limited to the liver, but that could not be treated with surgery or thermoablation (a technique that uses controlled temperatures to destroy the tumour).
The main goal of the study was to track how long each treatment could be maintained before it was considered a ‘’failure’’. However, the definition of failure was different for the two approaches:
- Atezo/Bev group: the treatment was considered a success if the cancer was kept under control from growing. It was marked as a failure if the disease showed clear progression (growth).
- TACE group: for this strategy, beyond progression, it was also considered a failure if the tumour remained ‘stable’ in the same dimension. For this approach, the goal was to enable active tumour reduction.
Overall, the results are highly encouraging. They confirm that combination therapy significantly outperforms TACE, providing patients with a longer period of disease control than those treated with TACE alone.
Takeaway: The Atezo/Bev combination represents a potential practice-changer for intermediate-stage HCC. However, the real clinical impact remains difficult to determine due to tumour heterogeneity. Further overall survival (OS) and other data are still awaited to fully evaluate the possible global clinical significance of this strategy.
Further Reading: Presented at ASCO GI 2026: Abstract 478, Galle et al.
- KEYNOTE 937 for HCC after resection or ablation
In this large trial involving 900 patients, researchers evaluated the efficacy of Pembrolizumab as an additional treatment for patients with HCC. The goal is to remove any traces of the tumour after the main cancer has been removed by surgery or destroyed through ablation.
Unfortunately, the results demonstrate no significant difference between patients who received Pembrolizumab and those in the control group. This means that the drug did not show a clear advantage over the standard approach in this specific setting.
However, to contextualise these findings, it is important to compare them with other major studies investigating other drugs. For instance, a study called IMbrave 050 (presented at ESMO GI 2024) showed similarly negative results to KEYNOTE 937. Instead, in another trial called CARES-009 (presented at ESMO 2025), demonstrate a more positive outcome. This study showed a significant improvement in the event-free survival (the time a patient lives without the cancer returning) with respect to surgery alone.
The reason for this success may lie in the strategy. While the other trials focused on treatment after the tumour was removed, this study used a preoperative approach, giving the treatment before surgery. This could suggest that the timing and strategy of a treatment may be just as important as the drug itself.
Takeaway: At this stage, Pembrolizumab does not seem to provide a clinical advantage over the current standard of care for patients post-surgery or ablation. However, negative results help researchers understand what doesn’t work, allowing them to focus on creating better options for future studies.
Further Reading: KEYNOTE 937 – Presented at ASCO GI 2026: Abstract 477, Chan et al; CARES 009 – Presented at ESMO GI 2025: Abstract 14700, Jian Zhou; IMbrave 050 – Presented at ESMO GI 2024: Abstract LBA39, Adam Yopp.
- ReFocus for Advanced Cholangiocarcinoma (CCA)
In this Phase I-II study, researchers investigated Lirafugratinib in patients with advanced/metastatic Cholangiocarcinoma (CCA). The study specifically focused on patients whose tumours have a specific genetic ‘fingerprint’, namely the FGFR2 mutation. Lirafugratinib was designed to be highly selective, meaning it acts like a precision key that only treats cancer cells carrying this specific mutation.
Moreover, one of the biggest challenges in cancer care is drug resistance, where a tumour changes its internal structure to protect itself from treatments. To this end, the drug under investigation was also developed to overcome this problem. Its main goal is to offer a more durable and effective treatment option for patients who have already undergone traditional chemotherapy.
The efficacy data were very promising, outperforming the current standard of care. With an Overall Response Rate (ORR) of 46.5% and a duration of response of 11.8 months, it shows an improvement over the currently used drugs, Pemigatinib and Futibatinib. Moreover, the median Overall Survival (OS) reached 22.8 months, marking a significant milestone for this patient population.
Regarding the safety profile, common adverse events included stomatitis, palmo-plantar erythrodysesthesia syndrome, nail toxicity, and retinal pigment epithelial detachment. Some cases saw spontaneous recovery, suggesting a manageable toxicity profile.
Takeaway: Lirafugratinib shows promising antitumour activity that appears superior to standard care. Future steps include evaluating a group of patients previously treated with FGFR inhibitors and maybe investigating its potential in frontline therapy through sequential treatment strategies.
Further Reading: Presented at ASCO GI 2026: Abstract 476, Hollebecque et al.
- ALTOPANC for Oligometastatic Pancreatic Adenocarcinoma
In this multicenter study across France and Belgium, researchers go through old medical records (between 2011 and 2024) to see how patients with a specific type of pancreatic cancer responded to treatments.
The study focused on patients with oligometastatic disease. This means the cancer has spread beyond the pancreas, but only to a maximum of two other organs.
Researchers wanted to evaluate the effectiveness of Metastases-Directed Therapies (MDT). These include surgery, radiotherapy and thermoablation, which can directly remove or destroy the new spots of cancer.
Among the treatments investigated, thermoablation showed the greatest survival benefit, helping patients live longer and remain cancer-free longer.
Takeaway: It is important to remember that this analysis looked at historical data, which can provide a strong foundation for future research.
Further Reading: Presented at ASCO GI 2026: Abstract 728, Parent et al.
Together, these studies demonstrate that the future of HBP cancer care can be improved through smarter strategies, genetic targeting, and insights from past clinical data. By evolving this approach, the medical and scientific community is building a more effective roadmap to improve the outcomes for every patient.
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