Expert Insights on Current Treatments for Hepatocellular Carcinoma: Clinical and Molecular Approaches and Bottlenecks to Progress

Abstract

Hepatocellular carcinoma (HCC) is a primary liver tumor that typically occurs in the setting of chronic liver disease/cirrhosis. Treatment modalities for HCC have evolved and given the variety of treatment options, a multi-disciplinary approach requiring input from surgical, medical, and radiation oncology, hepatology, and interventional radiology is necessary. Multiple advances have been made over the last decade regarding treatment of HCC, especially advanced disease. Resection and transplantation remain as cornerstone curative-intent treatment options. For patients who are not candidates for curative-intent therapy, exciting progress has been made in molecular and cellular approaches to systemic therapy for HCC including immunotherapies and tyrosine kinase inhibitors. Although the prognosis for advanced HCC remains poor, the armamentarium of therapies has increased, and valuable years of life can be gained with these therapies. While the main therapeutic modality for early-stage disease remains resection, multimodal immunotherapy has emerged as first-line treatment for advanced disease. We herein review different clinical and molecular treatment modalities related to the treatment of HCC, as well as provide insights into future directions for HCC treatment. We highlight how research and progress are needed to move into a new era of molecular and cellular treatments.

New Bioactive Peptides from the Mediterranean Seagrass Posidonia oceanica (L.) Delile and Their Impact on Antimicrobial Activity and Apoptosis of Human Cancer Cells

“…It is known that hepatocellular carcinoma, estimated as the fifth most common type of cancer worldwide and the second leading cause of death due to cancer in men, displays a generally poor prognosis, as well as that resection and transplantation are still considered as cornerstone treatment options [ 53 ]. Thus, significant efforts are being directed toward the development of new drugs, mainly from natural sources, that are able to exert minimal adverse effects along with the maximal therapeutic activity.…”

The effectiveness of ablative and non‐surgical therapies for early hepatocellular carcinoma: Systematic review and network meta‐analysis of randomised controlled trials

“…Currently RFA and MWA are the preferred ablative treatments in clinical practice 4,61 . MWA (rather than RFA) is now the standard of care in many centres, partly due to speed and ease of use 62 . Some treatments, such as cryoablation, HIFU and laser ablation, have not been widely adopted in Western centres.…”

“… 4 , 61 MWA (rather than RFA) is now the standard of care in many centres, partly due to speed and ease of use. 62 Some treatments, such as cryoablation, HIFU and laser ablation, have not been widely adopted in Western centres. PEI is no longer recommended unless other techniques are not possible.…”

A long‑term complete response to namodenoson in liver cancer with Child‑Pugh B cirrhosis: A case report

“…Considerations in HCC treatment include not only the disease stage, tumor characteristics, and patient's comorbidities but also liver function and the potential hepatotoxicity of the treatment, as the benefits of the treatment should be weighed against a potential deterioration in hepatic function ( 3 , 4 ). Liver function is often categorized by the Child-Pugh (CP) scoring system, which integrates multiple laboratory and clinical criteria.…”