Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths in both men and women worldwide. Therapeutic decision can be challenging since most of those patients have some degree of underlying liver dysfunction which affects the treatment options and patient survival. Surgical resection is generally reserved for patients with low tumor burden and reasonable hepatic function and performance status. Beyond surgical therapy, treatment options are limited and patient survival rates are diminished. This is further complicated by the fact that most patients with liver cancer are initially diagnosed with an advanced-stage tumor. Several locoregional therapies have been developed and evaluated in clinical trials in the recent years. Combination therapy appears to have more favorable outcome. However, the survival benefits of such therapies are variable. This chapter will review the different non-surgical therapeutic strategies for the treatment of HCC.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Fang Y, Chen W, Liang X, et al. Comparison of long-term effectiveness and complications of radiofrequency ablation with hepatectomy for small hepatocellular carcinoma. J Gastroenterol Hepatol. 2014;29(1):193–200. https://doi.org/10.1111/jgh.12441.
Majumdar A, Roccarina D, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS. Management of people with early- or very early-stage hepatocellular carcinoma: an attempted network meta-analysis. Cochrane Database Syst Rev. 2017;3(3):CD011650. Published 2017 Mar 28. https://doi.org/10.1002/14651858.CD011650.pub2.
Salem R, Gordon AC, Mouli S, Hickey R, Kallini J, Gabr A, Mulcahy MF, Baker T, Abecassis M, Miller FH, Yaghmai V, Sato K, Desai K, Thornburg B, Benson AB, Rademaker A, Ganger D, Kulik L, Lewandowski RJ. Y90 Radioembolization Significantly Prolongs Time to Progression Compared With Chemoembolization in Patients With Hepatocellular Carcinoma. Gastroenterology. 2016;151(6):1155–1163.e2. https://doi.org/10.1053/j.gastro.2016.08.029. Epub 2016 Aug 27. PMID: 27575820; PMCID: PMC5124387
Yoon SM, Lim YS, Park MJ, Kim SY, Cho B, Shim JH, Kim KM, Lee HC, Chung YH, Lee YS, Lee SG, Lee YS, Park JH, Kim JH. Stereotactic body radiation therapy as an alternative treatment for small hepatocellular carcinoma. PLoS One. 2013;8(11):e79854. https://doi.org/10.1371/journal.pone.0079854. PMID: 24255719; PMCID: PMC3821847.
Bush DA, Smith JC, Slater JD, Volk ML, Reeves ME, Cheng J, Grove R, de Vera ME. Randomized Clinical Trial Comparing Proton Beam Radiation Therapy with Transarterial Chemoembolization for Hepatocellular Carcinoma: Results of an Interim Analysis. Int J Radiat Oncol Biol Phys. 2016;95(1):477–82. https://doi.org/10.1016/j.ijrobp.2016.02.027. Epub 2016 Feb 13. PMID: 27084661
Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Häussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J. SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359(4):378–90. https://doi.org/10.1056/NEJMoa0708857. PMID: 18650514
Cheng AL, Guan Z, Chen Z, Tsao CJ, Qin S, Kim JS, Yang TS, Tak WY, Pan H, Yu S, Xu J, Fang F, Zou J, Lentini G, Voliotis D, Kang YK. Efficacy and safety of sorafenib in patients with advanced hepatocellular carcinoma according to baseline status: subset analyses of the phase III Sorafenib Asia-Pacific trial. Eur J Cancer. 2012;48(10):1452–65. https://doi.org/10.1016/j.ejca.2011.12.006. Epub 2012 Jan 10. PMID: 22240282
Kudo M, Finn RS, Qin S, Han KH, Ikeda K, Piscaglia F, Baron A, Park JW, Han G, Jassem J, Blanc JF, Vogel A, Komov D, Evans TRJ, Lopez C, Dutcus C, Guo M, Saito K, Kraljevic S, Tamai T, Ren M, Cheng AL. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018;391(10126):1163–73. https://doi.org/10.1016/S0140-6736(18)30207-1. PMID: 29433850
Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, Pracht M, Yokosuka O, Rosmorduc O, Breder V, Gerolami R, Masi G, Ross PJ, Song T, Bronowicki JP, Ollivier-Hourmand I, Kudo M, Cheng AL, Llovet JM, Finn RS, MA LB, Baumhauer A, Meinhardt G, Han G. RESORCE Investigators. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;389(10064):56–66. https://doi.org/10.1016/S0140-6736(16)32453-9. Epub 2016 Dec 6. Erratum in: Lancet. 2017 Jan 7;389(10064):36. PMID: 27932229.
Abou-Alfa GK, Meyer T, Cheng AL, El-Khoueiry AB, Rimassa L, Ryoo BY, Cicin I, Merle P, Chen Y, Park JW, Blanc JF, Bolondi L, Klümpen HJ, Chan SL, Zagonel V, Pressiani T, Ryu MH, Venook AP, Hessel C, Borgman-Hagey AE, Schwab G, Kelley RK. Cabozantinib in patients with advanced and progressing hepatocellular carcinoma. N Engl J Med. 2018;379(1):54–63. https://doi.org/10.1056/NEJMoa1717002. PMID: 29972759; PMCID: PMC7523244.
Yopp AC, Mansour JC, Beg MS, Arenas J, Trimmer C, Reddick M, Pedrosa I, Khatri G, Yakoo T, Meyer JJ, Shaw J, Marrero JA, Singal AG. Establishment of a multidisciplinary hepatocellular carcinoma clinic is associated with improved clinical outcome. Ann Surg Oncol. 21(4):1287–95. https://doi.org/10.1245/s10434-013-3413-8. Epub 2013 Dec 7. PMID: 24318095; PMCID: PMC5612826.
Li JW, Goh BBG, Chang PE, Tan CK. Barcelona Clinic Liver Cancer outperforms Hong Kong Liver Cancer staging of hepatocellular carcinoma in multiethnic Asians: real-world perspective. World J Gastroenterol. 2017;23(22):4054–63.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this entry
Cite this entry
Safra, A. (2022). Medical Management of Hepatocellular Carcinoma. In: Doria, C., Rogart, J.N. (eds) Hepato-Pancreato-Biliary Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-41683-6_6
Download citation
DOI: https://doi.org/10.1007/978-3-030-41683-6_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-41682-9
Online ISBN: 978-3-030-41683-6
eBook Packages: MedicineReference Module Medicine