Recent updates in the use of pharmacological therapies for downstaging in patients with hepatocellular carcinoma.

The newly developed pharmacological therapies, such as lenvatinib, atezolizumab plus bevacizumab, or durvalumab plus tremelimumab, showed a high objective response rate of up to 30%. Although various tumor statuses in advanced HCC hamper detailed analysis of successful conversion rate, the novel combined immunotherapies are expected to provide more opportunities for subsequent curative surgery for initially unresectable advanced HCC. The conversion treatment strategies for unresectable HCC should be separately discussed for 'technically resectable but oncologically unfavorable' HCC and metastatic or invasive HCC beyond curative surgical treatments. The optimal downstaging treatment strategy for advanced HCC is awaited. Elucidation of preoperatively available factors that predict successful downstaging will allow the tailoring of promising initial treatments leading to conversion surgery.