Systemic therapy for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a common cancer worldwide. Most patients present at a stage when surgical resection is no longer possible, and face a dismal prognosis. Locoregional and intra-arterial treatments are feasible and effective only in selected patients with disease confined to the liver. For patients with extrahepatic disease or a blocked portal venous system, systemic chemotherapy is the only treatment option available. Systemic therapy has not been successful in the past, with very low response rates to single-agent chemotherapy. Recently, however, there have been reports that combination chemotherapy with currently available agents may make some initially unresectable tumors resectable and, in some cases, induce complete pathologic responses. This has led to a reconsideration of systemic therapy for HCC, the current status of which is described in this review.