Advances in managing hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Medical Oncology
• Interventional Radiology

Background:

• Hepatocellular carcinoma (HCC) treatment selection depends on tumor characteristics and liver function.
• Surgical resection is standard for eligible patients, while liver transplantation is preferred for those with advanced cirrhosis or post-resection recurrence.
• Ablative therapies and emerging systemic agents are crucial for palliation, tumor destruction, and downstaging.

Purpose of the Study:

• To review current and novel treatment modalities for hepatocellular carcinoma.
• To highlight advancements in surgical, ablative, and systemic therapies for HCC.
• To provide an overview of emerging technologies and drugs in HCC management.

Main Methods:

• Literature review of surgical resection, liver transplantation, and ablative techniques (RFA, MWA, TACE, TARE, IRE).
• Analysis of current systemic therapies, including approved agents like sorafenib and investigational drugs (tyrosine kinase inhibitors, bevacizumab, ramucirumab, axitinib, tivantinib).
• Discussion of combination therapies and their ongoing investigation in clinical trials.

Main Results:

• Surgical resection and liver transplantation remain primary treatment options based on patient-specific factors.
• Ablative techniques offer palliative and downstaging benefits, enabling transplantation candidacy.
• Sorafenib is the sole FDA-approved chemotherapy; several other agents are under investigation with varying results.

Conclusions:

• Treatment for hepatocellular carcinoma is multimodal, tailored to tumor stage and patient condition.
• Ongoing research focuses on novel systemic therapies and combinations to improve HCC outcomes.
• Advancements in ablative and targeted therapies are expanding treatment options for liver cancer.