Johns Hopkins Experts Co-Author New Treatment Framework for Liver Cancer

A consortium of North American liver cancer specialists has introduced a new framework for treating hepatocellular carcinoma (HCC), the most common primary cancer of the liver. Called BEACON-HCC, the system is designed to help clinicians match treatment strategies to the biological and anatomical features of each patient’s disease rather than relying primarily on a single stage-based pathway. The recommendations were published Aug. 7 in Hepatology by HCC-LIVE, a collaborative group of experts from major cancer centers in North America and Europe.

HCC is a particularly complex cancer because treatment decisions are shaped not only by the size and number of tumors, but also by liver function, cirrhosis, vascular invasion, tumor biology and the patient’s overall health. These variables determine whether a tumor can be removed surgically, treated locally, targeted with radiation or managed with drugs that circulate throughout the body. BEACON-HCC brings these factors together in a clinical framework intended to reflect the way multidisciplinary liver cancer teams increasingly make decisions.

For nearly three decades, many physicians have used the Barcelona Clinic Liver Cancer, or BCLC, system to classify HCC and recommend treatment. According to Mark Yarchoan, M.D., an associate professor of oncology at the Johns Hopkins University School of Medicine and a BEACON-HCC co-author, the therapeutic landscape has changed substantially since the BCLC system was developed. New radiation techniques, catheter-based treatments and immune-based drug combinations have expanded the options available to patients, sometimes creating a gap between formal staging recommendations and the treatments offered at specialized centers.

One important difference concerns tumors that have invaded blood vessels. Under traditional staging approaches, vascular invasion often places a patient in an advanced disease category for which systemic therapy alone is recommended. However, Yarchoan said that vascular invasion does not always eliminate the possibility of remission or aggressive local treatment. In a prospective clinical trial at Johns Hopkins, selected patients with vascular invasion underwent potentially curative surgical resection, suggesting that some individuals classified as having advanced disease may still benefit from carefully chosen interventions aimed at eliminating the tumor.

Radiation therapy is another area in which clinical practice has evolved. Earlier versions of the BCLC framework gave external beam radiation therapy a limited role, but newer clinical evidence supports its use in selected patients as either a primary treatment or part of a combined strategy. External beam radiation uses high-energy photons or other radiation beams to damage the DNA of cancer cells, preventing them from dividing and eventually causing tumor cell death. Modern image-guided techniques can focus radiation on liver tumors while reducing exposure to surrounding healthy tissue.

BEACON-HCC also incorporates transarterial radioembolization, a minimally invasive procedure that exploits the liver’s distinctive blood supply. Liver tumors receive much of their blood from the hepatic artery, while healthy liver tissue is supplied predominantly by the portal vein. During radioembolization, physicians guide a catheter into arteries feeding the tumor and release tiny radioactive particles, often called microspheres. The particles become lodged near the cancer and deliver radiation from inside the tumor, allowing treatment to be concentrated in the diseased tissue.

Systemic therapies are included as another major component of the framework. These treatments can include immune checkpoint inhibitors, which help restore the immune system’s ability to recognize and attack cancer cells, as well as targeted drugs that interfere with signaling pathways involved in tumor growth and blood-vessel formation. Combination regimens may work throughout the body while also being paired with surgery, radiation or catheter-based procedures. The framework is intended to accommodate these evolving combinations rather than restrict patients to a single treatment category.

The 20 authors evaluated BEACON-HCC using 29 de-identified patient cases collected from their institutions. Each case included clinical information and tumor imaging. The authors independently selected an initial treatment approach from options including surgical resection, liver transplantation and other locoregional or systemic therapies. The same cases were also reviewed by 18 North American HCC specialists who had not participated in developing the framework. Across the cases, the experts’ recommendations matched BEACON-HCC in 96.6% of decisions, compared with 72.4% agreement with the BCLC 2025 recommendations.

The authors emphasize that BEACON-HCC is not intended to replace clinical judgment or function as a rigid algorithm. Instead, it provides a structure for tumor boards and multidisciplinary clinics, where hepatologists, oncologists, surgeons, interventional radiologists and radiation oncologists weigh competing risks and benefits. Jeffrey Meyer, M.D., an associate professor of radiation oncology and molecular radiation sciences at Johns Hopkins, said the framework recognizes both the expanding range of available treatments and the unresolved questions surrounding their optimal use.

The need for more flexible treatment guidance is underscored by the continuing burden of HCC. It is the third-leading cause of cancer-related death worldwide and the leading cause of cancer-related death among patients with cirrhosis. Despite advances in screening and therapy, five-year survival remains below 25%. The BEACON-HCC authors say the framework will need to evolve as new systemic drugs, radiation technologies and liver-directed procedures enter clinical practice, but they hope it will help clinicians make more individualized decisions in a disease where no single factor reliably determines the best treatment.

News Publication Date: Aug. 7 (year not specified)

Web References: Johns Hopkins Medicine news release; Hepatology journal publication on BEACON-HCC

References: HCC-LIVE consortium, “BEACON-HCC” treatment framework, Hepatology