Challenges and reflections on conversion therapy for advanced hepatocellular carcinoma

With the continuous emergence of biotherapy drugs in recent years， great progress has been made in the systemic therapy for advanced liver cancer. Immune checkpoint inhibitors combined with anti-angiogenic targeted drugs has become the first-line regimen recommended for the treatment of advanced liver cancer and has achieved clear oncology benefits and survival benefits. The regimens for immunotherapy combined with local treatment continue to emerge and have clearly improved objective response rate， and targeted and immune therapeutic regimens combined with sequential surgical treatment are reshaping the treatment pattern of advanced liver cancer and have finally improved radical surgical resection rate and long-term survival rate. Such changes in treatment guided by immunotherapy with or without targeted therapy have brought great challenges and thus require meticulous thoughts. With exploration of immune and targeted therapies combined with sequential surgical regimen as an example， there is a series of new problems and challenges before they are widely applied in routine diagnosis and treatment， including the selection of drug combination regimens， the evaluation of therapeutic efficacy， the treatment of toxic and side effects， surgical standards and timing， postoperative adjuvant treatment regimens， the validation of long-term survival benefits， and the selection of second-line treatment regimens for primary and secondary drug resistance. This article puts forward some suggestions and thoughts for several key aspects.