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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2015; 21(28): 8478-8491
Published online Jul 28, 2015. doi: 10.3748/wjg.v21.i28.8478
Current and future treatments for hepatocellular carcinoma
Alexander Schlachterman, Willie W Craft Jr, Eric Hilgenfeldt, Avir Mitra, Roniel Cabrera
Alexander Schlachterman, Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States
Willie W Craft Jr, Department of Hospital Medicine, Upper Valley Medical Center, Troy, OH 45373, United States
Eric Hilgenfeldt, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32608, United States
Avir Mitra, Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, United States
Roniel Cabrera, Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States
Author contributions: Cabrera R was responsible for project design; Craft Jr WW, Hilgenfeldt E, Mitra A and Schlachterman A contributed equally to research, data analysis and writing of the manuscript.
Conflict-of-interest statement: There is no financial support from any source in this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Willie W Craft Jr, Assistant Director of Hospital Medicine, Upper Valley Medical Center, 3130 N County Rd 25A, Troy, OH 45373, United States. wcraf0@gmail.com
Telephone: +1-859-5525931
Received: December 4, 2014
Peer-review started: December 4, 2014
First decision: March 12, 2015
Revised: April 27, 2015
Accepted: June 26, 2015
Article in press: June 26, 2015
Published online: July 28, 2015
Abstract

Hepatocellular carcinoma (HCC) represents a unique challenge for physicians and patients. There is no definitively curative treatment. Rather, many treatment and management modalities exist with differing advantages and disadvantages. Both current guidelines and individual patient concerns must be taken into account in order to properly manage HCC. In addition, quality of life issues are particularly complex in patients with HCC and these concerns must also be factored into treatment strategies. Thus, considering all the options and their various pros and cons can quickly become complex for both clinicians and patients. In this review, we systematically discuss the current treatment modalities available for HCC, detailing relevant clinical data, risks and rewards and overall outcomes for each approach. Surgical options discussed include resection, transplantation and ablation. We also discuss the radiation modalities: conformal radiotherapy, yttrium 90 microspheres and proton and heavy ion radiotherapy. The biologic agent Sorafenib is discussed as a promising new approach, and recent clinical trials are reviewed. We then detail currently described molecular pathways implicated in the initiation and progression of HCC, and we explore the potential of each pathway as an avenue for drug exploitation. We hope this comprehensive and forward-looking review enables both clinicians and patients to understand various options and thereby make more informed decisions regarding this disease.

Keywords: Hepatocellular carcinoma, Hepatoma, Hepatocellular cancer, Liver cancer, Adult, Liver cell carcinoma, Liver cell carcinoma, Adult, Liver neoplasm, Hepatic neoplasm

Core tip: Hepatocellular carcinoma (HCC), depending on the stage, has several treatment options including surgery, radiotherapy and biological agents such as Sorafenib. For both practitioners and patients these treatment modalities all offer advantages and disadvantages over one another. The question of when to use each modality remains an active field of debate. In order to provide clarity in this regard, we review currently used treatment methods along with the relevant data supporting or refuting them. Additionally, we then discuss molecular pathways involved in HCC that could be, and in some cases already are being, exploited for potential future drug therapy.