Hepatocellular Carcinoma Chemoprevention with Generic Agents

Abstract

Liver cancer, mainly hepatocellular carcinoma (HCC), remains a major cause of cancer-related death worldwide. With the global epidemic of obesity, the major HCC etiologies have been dynamically shifting from viral to metabolic liver diseases. This change has made HCC prevention difficult with increasingly elusive at-risk populations as rational target for preventive interventions. Besides ongoing efforts to reduce obesity and metabolic disorders, chemoprevention in patients who already have metabolic liver diseases will have a significant impact on the poor HCC prognosis. Hepatitis B- and C-related HCC incidences have been substantially reduced by the new anti-virals, but HCC risk can persist over a decade even after successful viral treatment, highlighting the need for HCC-preventive measures also in these patients. Experimental and retrospective studies have suggested potential utility of generic agents such as lipophilic statins and aspirin for HCC chemoprevention given their well characterized safety profile, although anticipated efficacy may be modest. In this review, we overview recent clinical and translational studies of generic agents in the context of HCC chemoprevention under the contemporary HCC etiologies. We also discuss newly emerging approaches to overcome the challenges in clinical testing of the agents to facilitate their clinical translation.

Suboptimal Performance of Hepatocellular Carcinoma Prediction Models in Patients with Hepatitis B Virus-Related Cirrhosis

“…Fourth, the evaluation of new biomarkers for chronic HBV infection (e.g., quantitative HBV surface antigen, serum HBV RNA, hepatitis B core-related antigen, or specific HBV mutants) was limited because of the retrospective nature of our study [46][47][48]. Likewise, the role of other metabolic factors should be assessed in the further studies [11,12,49,50]. Finally, the present study cannot clarify whether this phenomenon is specific to the HBV or also present in the other etiologies.…”

Statin use is associated with better post‐operative prognosis among patients with hepatitis B virus‐related hepatocellular carcinoma

“…Although many studies have examined the association between statins and a decreased risk of hepatocarcinogenesis, 24,[30][31][32][33][34][35][36][37][38] studies evaluating the preventive effect of statins in this specific population, such as patients with HBV-related HCC receiving surgical resection, are scarce. Our study had several strengths.…”

Non-Alcoholic Fatty Liver Disease and the Risk of Future Hepatocarcinoma

“…Chemopreventive agents are one of the primary pharmacological approaches utilized in the treatment of hepatocarcinoma in patients with NAFLD (35). By selectively inhibiting pathways implicated in the progression and development of liver cancer, including inflammation, oxidative stress, and cell proliferation, these agents achieve their effects.…”