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Treatment of intermediate-stage hepatocellular carcinoma
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Treatment of intermediate-stage hepatocellular carcinoma
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Journal Article
Treatment of intermediate-stage hepatocellular carcinoma
2014
Overview
Key Points
A number of treatments are available for hepatocellular carcinoma (HCC), and their allocation—as well as disease prognosis—is influenced by tumour stage and the degree of liver-function impairment
The current definition of intermediate-stage HCC (Barcelona Clinic Liver Cancer [BCLC] stage B) is extensive multifocal disease confined to the liver, with preserved liver function and no cancer-related symptoms
Transarterial chemoembolization (TACE) is considered the standard treatment for intermediate-stage HCC in patients with preserved liver function and no cancer-related symptoms
Major efforts have been made to improve outcomes among patients treated with TACE; accurate technique together with appropriate patient selection is key to obtaining the best results
Sorafenib, the only systemic treatment associated with a survival benefit in HCC, should be considered for patients with BCLC stage B HCC who are not eligible for TACE
Radioembolization has antitumoural efficacy in patients with intermediate-stage HCC, but evidence of survival benefit has not been presented and is awaited
The treatment options available for hepatocellular carcinoma (HCC) vary depending on prognostic factors that include tumour characteristics and clinical status, particularly with regard to liver function. This Review discusses the links between disease phenotype, prognosis and therapy, focusing on the subclassification of patients with intermediate-stage HCC following the BCLC staging system, who are usually ineligible for curative resection and ablation treatments or liver transplantation; the therapies that are available for this patient subgroup are described.
Hepatocellular carcinoma (HCC)—closely associated with liver cirrhosis and, in fact, the main cause of death in patients with such disease—is now recognized as one of the most-prevalent and lethal neoplasms worldwide. Prognosis and allocation of the multiple available treatment options for patients with HCC are influenced not only by tumour stage, but also by the degree of liver-function impairment. Therefore, accurate assessment and classification of disease is important for patient management. According to the Barcelona Clinic Liver Cancer (BCLC) algorithm, intermediate-stage HCC is defined as extensive multifocal disease without vascular invasion in patients with preserved liver function and absence of cancer-related symptoms; in this context, transarterial chemoembolization (TACE) is considered the standard treatment. The use of drug-eluting beads has enabled standardization of this procedure, resulting in higher reproducibility and tolerability of the treatment. Nevertheless, not all patients with intermediate-stage HCC are good candidates for TACE and, for such patients in whom TACE is not appropriate or has failed, other treatments can be considered, including sorafenib. Radioembolization is a promising alternative that deserves further prospective studies. Herein, we review the current approaches used to accurately stratify patients with intermediate-stage HCC and subsequently allocate the most-appropriate treatments. The key developments in therapeutic strategies are also discussed.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Antineoplastic Agents - administration & dosage
/ Antineoplastic Agents - therapeutic use
/ Carcinoma, Hepatocellular - classification
/ Carcinoma, Hepatocellular - pathology
/ Carcinoma, Hepatocellular - physiopathology
/ Carcinoma, Hepatocellular - therapy
/ Chemoembolization, Therapeutic
/ Hepatoma
/ Humans
/ Liver Neoplasms - classification
/ Liver Neoplasms - physiopathology
/ Niacinamide - analogs & derivatives
/ Niacinamide - therapeutic use
/ Oncology
