Comprehensive Review of Hepatocellular Carcinoma in India: Current Challenges and Future Directions

Abstract

There is not much information on hepatocellular carcinoma (HCC) in India. Here, we review the existing data, available treatment choices, and future directions in HCC management. An extensive search was conducted through PubMed and MEDLINE for studies published between January 2000 and June 2022 on the epidemiology of HCC in India using the following key words: atezolizumab, BCLC staging, hepatocellular carcinoma, immune checkpoint inhibitors, immunotherapy, and programmed cell death ligand-1, with the filters humans and English language. The most frequent risk factors for the development of HCC in India include nonalcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infection, liver cirrhosis, and alcohol intake. On the basis of new findings, the Barcelona Clinic Liver Cancer (BCLC) Staging Criteria need to be revised. As most cases in India are discovered at a later stage, curative treatments such as surgical resection, ablation, or liver transplantation may not be an option. Clinical trials are underway for a number of immune checkpoint drugs that target cytotoxic T-cell lymphocyte-4 and programmed cell death-1/programmed cell death-ligand 1. In India, phase III trials of atezolizumab in combination with other drugs are underway for the treatment of various malignancies. Renin angiotensin system inhibitors, antivirals, primary hepatocyte transplantation, and bioartificial liver devices are among the future options for the management of HCC. In developing countries like India, HCC is often diagnosed at an advanced stage because of a delay in routine testing or screening. Therefore, developing effective treatment regimens for such stages is critical. Immunotherapy is a promising treatment option that has the potential to increase overall response and survival rate.

Association between antithrombotic agents use and hepatocellular carcinoma risk: a two-sample Mendelian randomization analysis

“…Hepatitis B infections are at present the main risk factors for HCC. Moreover, the presence of cirrhosis, metabolic disorders, and autoimmune diseases as well as genetic predisposition are factors increasing the risk of HCC (Shetty and Kellarai, 2022). Surgical resection represents the established therapeutic approach for HCC patients with good liver function and no obvious vascular invasion or distant metastasis.…”

Association between sleep traits and primary liver cancer: A Mendelian randomization analysis

“…PLC is a heterogeneous group of diseases, including hepatocellular carcinoma, which constitutes over 90%, intrahepatic cholangiocarcinoma and combined hepatocellular cholangiocarcinoma. Various risk factors have been identified that can heighten the probability of developing PLC, including smoking, exposure to aflatoxin, hereditary hemochromatosis, infection with hepatitis B and C viruses, cirrhosis, chronic biliary diseases, choledocholithiasis, autoimmune diseases like autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cholangitis, as well as metabolic disorders including diabetes and non‐alcoholic fatty liver disease 4 …”

“…Various risk factors have been identified that can heighten the probability of developing PLC, including smoking, exposure to aflatoxin, hereditary hemochromatosis, infection with hepatitis B and C viruses, cirrhosis, chronic biliary diseases, choledocholithiasis, autoimmune diseases like autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cholangitis, as well as metabolic disorders including diabetes and non-alcoholic fatty liver disease. 4 In recent years, researchers have paid more attention to the impact of living habits on the incidence and development of disease. More people are facing sleep problems such as insomnia, inadequate sleep duration, obstructive sleep apnea (OSA) and daytime napping.…”

Fabrication of Porphyrin Based Colorimetric Sensor for the Detection of Liver Cirrhosis Biomarker

“…The incidence of liver cancer has been on the rise in recent years, and it is estimated that by 2030, it will become the second leading cause of cancer-related deaths worldwide. 1 When liver cells are damaged or destroyed due to various factors, such as chronic hepatitis B or C infections, excessive alcohol consumption, or exposure to toxins, the liver tries to repair itself by regenerating new cells. However, this process can sometimes go awry and result in the formation of cancerous cells.…”

“…3 Therefore, for successful treatment and a high patient survival rate, early detection of liver cancer is the holy grail in liver cancer study. 4 It is found that many patients with liver disease like hepatocellular carcinoma, liver fibrosis, and cirrhosis etc. exhaled mixture of specific VOCs which would have normally not present if the liver would have functioning well.…”