Advanced hepatocellular carcinoma and sorafenib: Diagnosis, indications, clinical and radiological follow-up

Table 2 Main systemic therapies in advanced hepatocellular carcinoma treatment

Systemic therapies
The only drug approved for the treatment of advanced HCC. Patients treated with sorafenib have longer OS then placebo group in the two largest studies
The efficacy of this treatment is linked to liver function: Child B patients have much lower survival than Child A ones (5.5 mo vs 11.3 mo). Child C patients have very poor prognosis and seem not to be suitable for sorafenib therapy (1.6 mo)
Patient treated with sorafenib has longer survival than those treated with sunitinib. No difference in OS has been found comparing sorafenib treatment to brivanib
Some combination therapies have been proposed, but none of these has shown superiority compared to sorafenib alone
At now there is no therapeutic plan approved as second line in advanced HCC pretreated with sorafenib
Some drugs as capecitabine, brivanib, sunitinib, everolimus have been tested in monotherapy, moreover some combination therapies as erlotinib with sorafenib, and gemcitabine with oxaliplatin have been evaluated as second line options, but all of them have not given significant results
Many studies are still in progress and some interesting, but preliminary results have been obtained in patients with high expression of c-met in treatment with brivanib

HCC: Hepatocellular carcinoma; OS: Overall survival.