Advances in management of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the leading causes of death by cancer worldwide due to a dismal prognosis. The aim of this review is to summarize the main advances in the pathophysiology and management of HCC.

Genomic analysis has recently delineated the key signaling pathways aberrantly deregulated in HCC (telomere maintenance, cell cycle gene, Wnt/β-catenin, epigenetic modifier, oxidative stress etc.). Major advances in the clinical care of patients with HCC are helping to refine the diagnosis algorithm and tumor staging. Extension of criteria for liver transplantation, but also for liver resection and percutaneous ablation, aims to increase the number of patients being treated in a curative attempt. Moreover, radioembolization is a competitor for transarterial chemoembolization in Barcelona clinic liver cancer B patients, and sorafenib in Barcelona clinic liver cancer C with tumor portal thrombosis. In advanced HCC, sorafenib is the standard of first-line care and regorafenib as a second line.

New concepts on liver resection, percutaneous ablation or liver transplantation aim to extend the numbers of patients treated for HCC in curative attempts. Moreover, immunotherapy (anti death protein 1) and biotherapy adapted to tumor biology seem promising and are currently being tested in advanced stages.