Treatment Lines in Hepatocellular Carcinoma

Area of Science:

• Hepatology
• Oncology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally, frequently arising in patients with liver cirrhosis.
• Effective HCC management necessitates interdisciplinary evaluation, critically considering functional liver reserve.

Purpose of the Study:

• To review current treatment modalities for HCC.
• To explore novel systemic therapeutic strategies for HCC management.

Main Methods:

• Review of randomized controlled trials and meta-analyses focused on HCC treatments.
• Emphasis on systemic therapies and their integration with locoregional interventions.

Main Results:

• Resection and ablation are curative for early-stage HCC with preserved liver function.
• Liver transplantation provides superior tumor control and survival but faces donor organ limitations.
• Transarterial chemoembolization serves as a bridge to transplant and a palliative option.
• Tyrosine kinase inhibitors (lenvatinib, regorafenib, cabozantinib) and ramucirumab demonstrate clinical benefit in HCC.

Conclusions:

• Interdisciplinary decision-making is crucial for HCC treatment.
• Liver transplantation is a primary curative option, especially for T2 stage HCC.
• Early response assessment guides sequential treatment strategies to prevent hepatic decompensation.