The treatment of intermediate stage tumours beyond TACE: From surgery to systemic therapy

Galle, Peter R.; Tovoli, Francesco; Foerster, Friedrich; Wörns, Marcus A.; Cucchetti, Alessandro; Bolondi, Luigi

doi:10.1016/j.jhep.2017.03.007

Cited by 199 publications

(176 citation statements)

References 160 publications

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“…However, giving that intermediate HCC patients comprise a heterogeneous population with diverse liver function, tumor burden, and disease etiologies, TACE might be over‐used and it may not be appropriate for all intermediate HCC patients (Galle et al, ). Studies showed that not all patients in this stage can gain a survival benefit from TACE, and some patient subpopulations may benefit more from other treatment options (Raoul et al, ).…”

Section: Treatments Of Intermediate Hccmentioning

confidence: 99%

Therapeutic advances for patients with intermediate hepatocellular carcinoma

Sun

Yin

Zhang

et al. 2019

Journal Cellular Physiology

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Hepatocellular carcinoma (HCC) is the fifth most common malignant tumor and constitutes a major health threat globally. Intermediate HCC (Barcelona Clinic Liver Cancer Staging, stage B) encompasses a wide range of patients and is characterized by substantial heterogeneity with varying tumor burdens and liver functions. Therefore, it is paramount to evaluate the patient's overall conditions and to select the most appropriate therapy based on available evidence. Transarterial chemoembolization is the recommended first‐line therapy for intermediate HCC patients. However, in clinical practice, other treatment options are also used as alternative therapies, such as hepatic resection, percutaneous thermal ablation, radiotherapy (RT), systemic treatment, immunotherapy, and so forth. In this review, we will introduce current treatment strategies for intermediate HCC, discuss their advantages and disadvantages, and propose future directions.

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Section: Treatments Of Intermediate Hccmentioning

confidence: 99%

Therapeutic advances for patients with intermediate hepatocellular carcinoma

Sun

Yin

Zhang

et al. 2019

Journal Cellular Physiology

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“…The most important differences concern liver resection. While the AASLD/EASL guidelines recommend the presence of a single nodule and Child‐Pugh A functional status, other guidelines accept multinodularity and a Child‐Pugh B status in selected cases, 7 an indication which is also discussed in the West 8 …”

Section: Discrepancies Between Easl Aasld and Apasl Guidelines On Hementioning

confidence: 99%

Abstracts

Bourlière

Pol

2019

Liver International

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These proceedings of the PHC 2019 reflect the remarkable recent advances in all fields of hepatology that are covered during this conference.Thirty years after the discovery of the hepatitis C virus (HCV), we can tell our patients that they have almost a 100% chance of cure with pangenotypic DAAs. The rare patients who relapse with resistanceassociated substitutions after DAAs therapy are cured with appropriate retreatment. Cure means eradication of HCV infection with improved quality of life and outcome. Although the WHO HCV program, which seeks the elimination of hepatitis C by 2030 may be difficult to achieve, it is accompanied by active national programs worldwide.We can tell our patients with hepatitis B that they have a 100% chance of viral suppression. Long term studies of patients receiving last generation NUCs demonstrate sustained remission without resistance, regression of liver lesions and improved outcome. WHO has set priorities to achieve global goals including more effective vaccination and easy access to therapy programs. The next objective is a cure. This objective becomes realistic with the development of effective drugs of different viral targets. Future treatment will certainly include combinations that are adapted to the different phases of hepatitis B. Patients with hepatitis delta can be told that new treatments are on the way. Ongoing phase 3 trials of Myrcludex and Lonafarnib should confirm their efficacy, which is synergistic in combination with interferon.Patients with NAFLD must be receiving counselling. However, in this emerging liver disease, which affects 25% of the population, | 2421 ABSTRACT life style counselling is only effective in a minority of patients. As we learned from NANB hepatitis before discovering the HCV, our lack of knowledge explains the problems we now face with NAFLD.The key issue is differentiating NASH from simple steatosis. There is An alternative option is the combination of SOF plus GLE/ PIB ± RBV for 12-16 weeks. Moreover, triple FDC is recommended either in combination with weight-based dose RBV and/ or to extend treatment to 16 or 14 weeks in very difficult-to-cure patients with NS5A RASs who have failed to achieve SVR twice after several DAAs regimens including protease and/or N5A inhibitors. SUMMARYIn conclusion, the single pill triple FDC SOF/VEL/VOX for 12 weeks or the triple combination SOF plus GLE/PIB with or without ribavirin for 12 weeks achieves a 96% SVR rate in the few patients who fail DAAs combinations, even the most recent pangenotypic regimens.Therefore, with the current available rescue regimens, DAAs treatment failure is no longer significant issue.

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“…In line with our recent review of the evidence for the various treatment options for intermediate HCC (8), the Chinese guidelines suggest an array of methods for more advanced HCC stages: resection remains an option as long as there is no vascular invasion or extrahepatic spread (equivalent to BCLC 0-B). Transarterial chemoembolization (TACE) is valid as long as liver function is CHILD A or B, and the performance status is >3 (equivalent to BCLC A-C).…”

mentioning

confidence: 90%