Comprehensive management of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma(HCC)is nowadays one of the leading common causes of cancer death and mostly occurs in hepatitis B endemic areas.Typically,HCC patients presented late and only about 20% of the patients are amendable to surgical interventions.Surgical resection is the main curative treatment option.Nevertheless,the recurrence rate after potential curative liver resection is still very high.On the other hand,liver transplantation is the treatment of choice for early small HCC but its application is limited by the availability of liver grafts.Radiofrequency ablation is more commonly used in cirrhotic patients with small tumours who are not surgical candidates.Nowadays,transarterial chemoembolisation,drugeluting bead transarterial chemoembolisation and radioembolisation are the mainstay of treatments for the patients with intermediate HCC.Other systemic approaches,such as hormonal therapy,immunotherapy and chemotherapy have disappointing results.In particular,HCC is highly refractory to cytotoxic chemotherapy.This is no convincing evidence thus far that systemic chemotherapy improves overall survival in advanced HCC patients.Recently,encouraging results have been shown in using sorafenib in the treatment of advanced HCC patients.Similar to sorafenib,other anti-angiogenic multi-targeted tyrosine kinase inhibitors,such as pazopanib,brivanib and axitinib also show promising activity in various stages of clinical trials.There is an urgent need to identify biomarkers that may guide the rational use of sorafenib and other targeted agents in the era of personalised medicine.More importantly,the multidisciplinary model in managing HCC patients is the important key to the future success.