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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Management of patients with intermediate stage hepatocellular carcinoma
David Prince1, Ken Liu1, Weiqi Xu2
1AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Insights
Hepatocellular carcinoma (HCC) management for intermediate stage BCLC-B patients is complex. This review explores current treatments beyond transarterial chemoembolization (TACE) and highlights emerging therapies for this heterogeneous group.
Area of Science:
- Hepatology
- Oncology
- Gastroenterology
Background:
- Hepatocellular carcinoma (HCC) presents a significant global health challenge, with intermediate stage (BCLC B) representing up to 30% of diagnoses.
- This stage is characterized by a broad spectrum of tumor burden, necessitating further subclassification.
- Current standard of care, transarterial chemoembolization (TACE), offers modest outcomes and is not universally applied.
Purpose of the Study:
- To review current classifications and management strategies for intermediate stage HCC (BCLC B).
- To highlight recent advancements and alternative therapies beyond TACE for this patient group.
Main Methods:
- Comprehensive literature review of BCLC staging and intermediate HCC management.
- Analysis of current treatment paradigms including TACE, curative options, radiotherapy, and systemic therapies.
- Synthesis of recent developments and promising therapeutic approaches.
Main Results:
- Intermediate stage HCC is a heterogeneous group with diverse tumor burdens.
- Transarterial chemoembolization (TACE) is the standard but has limitations and is not used in all patients.
- A range of alternative and emerging therapies, including curative treatments, radiotherapy, and systemic therapies, show promise in select subgroups.
Conclusions:
- Effective management of intermediate stage HCC requires personalized approaches beyond standard TACE.
- Further research and clinical trials are crucial to optimize treatment strategies for this heterogeneous population.
- Exploring novel combinations and tailored therapies is key to improving outcomes in intermediate HCC.
Abstract:
Hepatocellular carcinoma (HCC) causes a significant health burden globally and its impact is expected to increase in the coming years. Intermediate stage HCC, as defined by the Barcelona Clinic Liver Cancer (BCLC) system stage B, represents up to 30% of patients at diagnosis and encompasses a broad spectrum of tumor burden. Several attempts have been made to further subclassify this heterogenous group. The current standard of care recommended by BCLC for intermediate stage HCC patients is transarterial chemoembolization (TACE), with modest outcomes reported. While refinements have been made to TACE technique and patient selection, it remains non-curative. In the real-world setting, only 60% of patients with intermediate stage HCC receive TACE, with the remainder deviating to a range of other therapies that have shown promise in select patient subgroups. These include curative treatments (resection, ablation, and liver transplantation), radiotherapy (stereotactic and radioembolization), systemic therapies, and their combination. In this review, we summarize the classifications and current management for patients with intermediate stage HCC as well as highlight recent key developments in this space.
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