Treatment Algorithms for Managing Hepatocellular Carcinoma

Saraswat, Vivek A.; Pandey, Gaurav; Shetty, Shricharith

doi:10.1016/j.jceh.2014.05.004

Cited by 58 publications

(49 citation statements)

References 49 publications

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“…This agent carries a mild-to-moderate toxicity profile and exhibits antitumor activity against various solid tumors [17] . It was the first systemic agent that was proven to prolong the survival of patients with advanced HCC in two phase III trials [2,18] , and it is now the standard of care for systemically treated patients [5,[19][20][21][22] . The initial sorafenib dose recommended in the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trial and the Asia-Pacific trial was 800 mg/day, but since sorafenib came into clinical use, there have been reports of lower initial doses.…”

Section: Discussionmentioning

confidence: 99%

Hand-Foot Syndrome and Post-Progression Treatment Are the Good Predictors of Better Survival in Advanced Hepatocellular Carcinoma Treated with Sorafenib: A Multicenter Study

et al. 2017

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87.3-170.7) and the median overall survival (OS) was 392 days (95% CI: 316.0-468.0). The OS of the patients with ChildPugh class A HCC was significantly better than that of the patients with Child-Pugh class B HCC ( p < 0.0001). The survival curves for Child-Pugh class A-5 points and class A-6 points were significantly different, with that for class A-5 points being better ( p < 0.0001). A significant difference was observed between the patients who exhibited HFS and those who did not, with the former exhibiting a better survival rate ( p < 0.001). In addition, the survival rate of the patients who received post-progression treatment after sorafenib therapy was significantly better than that of the patients who did not ( p < 0.001). Conclusion: In sorafenib therapy, patients with HFS and those who received post-progression treatment exhibited good OS. © 2017 S. Karger AG, BaselKeywords Hepatocellular carcinoma · Sorafenib · Hand-foot syndrome Abstract Objective: To determine the relationship between treatment outcomes and hand-foot syndrome (HFS), and the relationship between survival rate and post-progression treatment after sorafenib therapy. Methods: The study assessed 314 patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib at 5 general hospitals in Kagawa Prefecture, Japan. Results: At the start of sorafenib therapy, 23.6% of the patients had HCC of a Child-Pugh class other than A. The initial sorafenib dose was 800 mg in 9.2% of the patients and 400 mg in 64.3%. Time to progression was 129 days (95% CI:

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Section: Discussionmentioning

confidence: 99%

Hand-Foot Syndrome and Post-Progression Treatment Are the Good Predictors of Better Survival in Advanced Hepatocellular Carcinoma Treated with Sorafenib: A Multicenter Study

et al. 2017

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“…However, MRI is emerging worldwide as a leading method for the diagnosis and staging of HCC, and it is the most sensitive method for the detection of small HCCs [11] . However, the combination of dual-phase CT-angiography in the arterial and portal phase with positron emission tomography (PET) imaging using (18)F-fluorodeoxyglucose [ (18)FDG] appears to be a sensitive method for the detection of HCC with the alternative presence of hypervascularity or hyperaccumulation of (18)FDG [12] . If the radiological pattern is not typical, the test should be repeated.…”

Section: Diagnosismentioning

confidence: 99%

“…For this reason, the Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy is most often used [9,17] because it includes information concerning the tumor, hepatic function and the general clinical status [18] . However, in spite of these facts, the TNM classification is used as the reference for pathological studies of surgical specimens.…”

Section: Stagingmentioning

confidence: 99%

Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

Soriano¹

2016

WJH

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The aim of liver transplantation (LT) for hepatocellular carcinoma (HCC) is to ensure a rate of disease-free survival similar to that of patients transplanted due to benign disease. Therefore, we are forced to adopt strict criteria when selecting candidates for LT and prioritizing patients on the waiting list (WL), to have clarified indications for bridging therapy for groups at risk for progression or recurrence, and to establish certain limits for downstaging therapies. Although the Milan criteria (MC) remain the standard and most employed criteria for indication of HCC patients for LT by far, in the coming years, criteria will be consolidated that take into account not only data regarding the size/ volume and number of tumors but also their biology. This criteria will mainly include the alpha fetoprotein (AFP) values and, in view of their wide variability, any of the published logarithmic models for the selection of candidates for LT. Bridging therapy is necessary for HCC patients on the WL who meet the MC and have the possibility of experiencing a delay for LT greater than 6 mo or any of the known risk factors for recurrence. It is difficult to define single AFP values that would indicate bridging therapy (200, 300 or 400 ng/mL); therefore, it is preferable to rely on the criteria of a French AFP model score > 2. Other single indications for bridging therapy include a tumor diameter greater than 3 cm, more than one tumor, and having an AFP slope greater than 15 ng/mL per month or > 50 ng/mL for three months during strict monitoring while on the WL. When considering the inclusion of patients on the WL who do not meet the MC, it is mandatory to determine their eligibility for downstaging therapy prior to inclusion. The upper limit for this therapy could be one lesion up to 8 cm, 2-3 lesions with a total tumor diameter up to 8 cm, or a total tumor volume of 115 cm 3 . Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future the WL should take into account the recently described HCC model for end-stage liver disease, which considers hepatic function, HCC size and the number and the log of AFP values. This formula has been calibrated with the survival data of non-HCC patients and produces a dynamic and more accurate assessment model.

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“…For this reason, a more specific system was developed, the Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy [9,10]. BCLC incorporates data of the tumor and the stage of hepatic function in addition to information regarding the general clinical status of the patient [11]. Alongside the BCLC system, the TNM classification is mainly used by pathologists as a reference for studies on surgical specimens.…”

Section: Treatment Options For Hccmentioning

confidence: 99%

HCC-Associated Liver Transplantation - Where Are the Limits and What Are the New Regulations?

Strassburg

2016

Visc Med

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Background: Hepatocellular carcinoma (HCC) represents an increasing health burden worldwide and a challenging disease both in terms of diagnosis and treatment. Methods: The literature available on PubMed for the period of 1990-2016 was reviewed with reference to liver allocation, HCC, liver transplantation (LT), and prediction, and the allocation rules of the German Transplant Act were reviewed. Results: Due to etiological and geographical diversity, HCC is not a homogeneous disease. In the vast majority of patients, HCC develops as a complication of chronic liver disease and cirrhosis. While most patients present with advanced HCC for which palliative strategies are the only available option, LT is the best treatment approach as it not only eliminates the diseased liver and the underlying hepatocarcinogenic mechanisms but also the cancer. The decision for LT is not an easy one to make, because outcome prediction, staging, bridging therapy, and recurrence prevention are difficult and are estimated against the background of the scarce resource of donor organs which are also competitively sought after by patients suffering from non-neoplastic terminal liver diseases, raising the issue of equality of chances in a rationed therapeutic modality. Currently, the Milan criteria are the best evaluated decision tool for LT, but many issues such as down-staging, favorable biological behavior during treatment, expansion of the morphological classification, molecular predictors, and individualized approaches are not yet satisfactorily addressed. Conclusion: In order to provide a fair and effective approach to LT in HCC, the employed allocation rules require continuous development and scientific evaluation. Recently, the allocation rules for standard exception priority according to the German Transplant Act have been revised to improve patient selection for LT in HCC.

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Treatment Algorithms for Managing Hepatocellular Carcinoma

Cited by 58 publications

References 49 publications

Hand-Foot Syndrome and Post-Progression Treatment Are the Good Predictors of Better Survival in Advanced Hepatocellular Carcinoma Treated with Sorafenib: A Multicenter Study

Hand-Foot Syndrome and Post-Progression Treatment Are the Good Predictors of Better Survival in Advanced Hepatocellular Carcinoma Treated with Sorafenib: A Multicenter Study

Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

HCC-Associated Liver Transplantation - Where Are the Limits and What Are the New Regulations?

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