Current Status of Management of Hepatocellular Carcinoma in The Gulf Region: Challenges and Recommendations

Abstract

The burden of hepatocellular carcinoma (HCC) is on the rise in the Gulf region, with most patients being diagnosed in the intermediate or advanced stages. Surgery is a treatment option for only a few, and the majority of patients receive either locoregional treatment (percutaneous ethanol injection, radiofrequency ablation, transarterial chemoembolization [TACE], radioembolization, radiotherapy, or transarterial radioembolization) or systemic therapy (for those ineligible for locoregional treatments or who do not benefit from TACE). The recent emergence of novel immunotherapies such as immune checkpoint inhibitors has begun to change the landscape of systemic HCC treatment in the Gulf. The combination of atezolizumab and bevacizumab is currently the preferred first-line therapy in patients not at risk of bleeding. Additionally, the HIMALAYA trial has demonstrated the superiority of the durvalumab plus tremelimumab combination (STRIDE regimen) therapy in efficacy and safety compared with sorafenib in patients with unresectable HCC. However, there is a lack of data on post-progression treatment after first-line therapy with either atezolizumab plus bevacizumab or durvalumab plus tremelimumab regimens, highlighting the need for better-designed studies for improved management of patients with unresectable HCC in the Gulf region.

Treatment Patterns and Recommendations for Improving the Management of Hepatocellular Carcinoma in Saudi Arabia

“…The results were reflective of earlier studies where viral-associated HCC was responsible for majority (77%) of the deaths due to HCC and was comparable to the global average. 5 The pathophysiology of viral-associated HCC includes liver inflammation, oxidative stress, and deregulation of cell signaling pathways. While HCV promotes cellular proliferation, steatosis, inflammatory processes, mitochondrial dysfunction, and insulin resistance, all leading to oxidative stress, genetic instability, and DNA damage, with liver cirrhosis and HCC as the likely outcomes, HBV infection is more oncogenic due to the integration of the viral and cellular DNA resulting in persistence of the virus despite virological suppression by nucleotide analogs.…”

“… 16 , 17 Individuals with HBV and HCV co-infection have a worse prognosis than infection with either virus alone as it is associated with more comorbidities, increased severity of liver disease, and a higher risk of HCC. 5 …”

Cytotoxic Activity of Phytoconstituents Isolated from Monotheca buxifolia against Hepatocellular Carcinoma Cell Line HepG2: In Vitro and Molecular Docking Studies

“…HCC accounts for approximately 90% of the cases of liver cancer and is associated with high morbidity and mortality. 12 Monotheca buxifolia species are found in hilly areas of Pakistan and have therapeutic uses such as antiseptic, for relieving gastrointestinal disorders, analgesic, anti-inflammatory, antipyretic, and for wound healings. 13 These plants are abundant in Dir Lower, Attock, Xhob Kala Chitta, and Chitral.…”

“…Liver cancer is a growing global health challenge, with an estimated annual incidence of >1 million cases worldwide by 2025. HCC accounts for approximately 90% of the cases of liver cancer and is associated with high morbidity and mortality …”

Metformin-Loaded Hyaluronic Acid-Derived Carbon Dots for Targeted Therapy against Hepatocellular Carcinoma by Glutamine Metabolic Reprogramming

“…Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide with an approximate incidence of >1 million cases by 2025. 1 Arising against a background of chronic liver diseases, the survival of HCC has been reported to be meager (3−5%), suggesting a poor prognosis that ascribes to a delayed phase of diagnosis in majority of the cases. 2 The aggressiveness of the disease is mostly responsible for the overall high mortality of HCC, having extremely limited effective therapeutic choices.…”