Neoadjuvant therapy in primary liver cancer: From the missing piece to a new paradigm

作者：Z J Li, Kui Ming Chan, Haojie Jin · 发表于：Hepatology Communications · 年份：2026 · DOI：10.1097/hc9.0000000000000977 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Liver physiology and pathology、Organ Transplantation Techniques and Outcomes

Neoadjuvant therapy has long been the missing piece in the treatment of primary liver malignancies. Despite the well-recognized burden of postoperative recurrence, the field has lacked robust randomized evidence to support perioperative intervention, and most available data have been retrospective, single-arm, or early-phase.1 As a result, upfront surgery has remained the default curative pathway, while the potential roles of preoperative systemic therapy in eradicating occult disease, testing tumor biology, and refining surgical selection have remained largely unproven. Recently, 2 clinical trials have separately demonstrated the efficacy of perioperative or neoadjuvant therapy in hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA), the 2 major forms of primary liver cancer. CARES-009 showed that perioperative camrelizumab plus rivoceranib significantly improved event-free survival in patients with resectable HCC at intermediate or high risk of recurrence.2 ZSAB-neoGOLP showed that neoadjuvant GOLP—gemcitabine, oxaliplatin, lenvatinib, and toripalimab—significantly prolonged event-free survival in patients with high-risk resectable iCCA.3 Together, these trials represent a landmark step toward evidence-based neoadjuvant therapy in primary liver cancer. CARES-009 may represent a turning point for perioperative therapy in resectable HCC, but it also raises an unresolved question central to the field. This randomized phase 2/3 trial was designed to test a ...