Treatment for Advanced Liver Cancer: Current Standard and the Future

Clinical Liver Disease (CLD) 

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Special Issue on HCC 
Volume13, Issue1

January 2019
Pages 13-19

Treatment for Advanced Hepatocellular Carcinoma: Current Standard and the Future 
Alisa Likhitsup M.D. Nataliya Razumilava M.D. Neehar D. Parikh M.D.
First published: 21 February 2019
https://doi.org/10.1002/cld.782

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Hepatocellular carcinoma (HCC) is the third leading cause of death worldwide with increasing incidence and mortality in the United States.1, 2 High HCC‐associated mortality is in part due to the high proportion of patients diagnosed with advanced stage HCC and historical lack of effective systemic therapies for HCC.

HCC staging is unique because liver function and functional status, in addition to tumor burden, are integral determinants of stage and prognosis. Although staging systems vary, parameters that define advanced stage HCC eligible for therapy include presence of portal vein tumor invasion and/or extrahepatic metastases, with relatively preserved liver function and functional status. Generally, systemic therapy trials excluded patients with Child Pugh class B and C cirrhosis, largely because of the competing risk for mortality with cirrhosis. Thus, for many therapies, there are little data on efficacy and tolerability in patients with more advanced liver disease. Systemic therapies may also be appropriate in those patients with unresectable HCC who are not eligible for or are unlikely to benefit from locoregional therapies, although the decision on timing of when to initiate systemic therapy in a patient with intermediate HCC who is eligible for recurrent locoregional therapy remains an open question. In this review, we discuss contemporary approaches and ongoing studies for the treatment of patients with advanced HCC.
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https://aasldpubs.onlinelibrary.wiley.com/journal/20462484

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