Review article: the management of hepatocellular carcinoma

Abstract

Aliment Pharmacol Ther 31, 461–476 Summary Background Hepatocellular carcinoma is the leading cause of death in cirrhosis. A majority of patients present at an advanced stage with poor prognosis. Aim To review the current screening, diagnosis and management strategies involved in hepatocellular carcinoma. Methods A literature search was performed using PubMed for publications with a predetermined search string to identify relevant studies. Results Hepatocellular carcinoma is dramatically increasing in incidence that is mostly attributed to chronic hepatitis C and non‐alcoholic fatty liver disease/non‐alcoholic steatohepatitis and its clinical phenotype diabetes and obesity. Cirrhosis is the major predisposing risk factor and its presence necessitates close surveillance for hepatocellular carcinoma with serial imaging studies. Hepatocellular carcinoma can be diagnosed by its unique radiological behaviour of arterial enhancement and washout on delayed images. The Barcelona Clinic Liver Cancer staging classification system is a clinically useful algorithm for the management of patients with hepatocellular carcinoma. The simultaneous presence of cirrhosis in the patients complicates their management and monitoring for cirrhosis‐related complications is important. Conclusions Early diagnosis and definitive treatment remains the key to long‐term outcome. A multidisciplinary approach is critical to the successful management of hepatocellular carcinoma. Studies combining sorafenib with locoregional or other targeted molecular therapies are likely to improve responses and outcome.

Prognostic factors in patients with advanced hepatocellular carcinoma treated with sorafenib

“…23,24 This was a national multicentre retrospective study of patients treated with sorafenib in 'real life' practice and, as such, comprised a broader range of patient types than were included in the Phase III studies. 8,9 In total, 148 HCC patients who were ineligible for loco-regional therapy received sorafenib in this study.…”

Sorafenib and hepatic arterial infusion chemotherapy for unresectable advanced hepatocellular carcinoma: A comparative study

“…In Japan, the use of sorafenib for unresectable hepatocellular carcinoma was approved in May 2009, and the indication for sorafenib may be expanded in the future. However, to date, the effect of sorafenib has only been compared with untreated groups, and further evidence is required to position sorafenib in the treatment algorithm for HCC, for which various treatment methods are available (7,8).…”

Real Life Treatment of Hepatocellular Carcinoma: Impact of Deviation from Guidelines for Recommended Therapy

“…Sorafenib is expensive, with an average cost of US $6,000 per month in different countries (Cabrera and Nelson, 2010), and can only be applied in countries DOI:http://dx.doi.org/10.7314/APJCP.2015.16.16.6929 Real-Life HCC Treatment -Influence on Outcome of Deviation from Therapy Guidelines with extensive financial resources for healthcare services (Parikh et al, 2008;Benson et al, 2009;Bruix and Sherman, 2011;Song et al, 2012). The monthly cost of sorafenib in Egypt is lower ($3,000 for a month's supply), yet this is close to the annual per-capita income, and is not reimbursed by national or most private insurance, and most patients have to pay out of their own resources.…”