Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2019; 25(28): 3704-3721
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3704
Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma
Clifford Akateh, Sylvester M Black, Lanla Conteh, Eric D Miller, Anne Noonan, Eric Elliott, Timothy M Pawlik, Allan Tsung, Jordan M Cloyd
Clifford Akateh, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Sylvester M Black, Division of Transplant Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Lanla Conteh, Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Eric D Miller, Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Anne Noonan, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Eric Elliott, Division of Diagnostic Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Timothy M Pawlik, Allan Tsung, Jordan M Cloyd, Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
Author contributions: Akateh C and Cloyd JM contributed to the study design, manuscript writing and critical revision. Black SM, Conteh L, Miller ED, Noonan A, Elliot E, Pawlik TM and Tsung A contributed to the manuscript writing and critical revision.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This is an open-access article that 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/
Corresponding author: Jordan M Cloyd, MD, Assistant Professor, Division of Surgical Oncology, The Ohio State Wexner Medical Center, 410 W 10th Ave, N-907, Columbus, OH 43210, United States. jordan.cloyd@osumc.edu
Telephone: +1-614-2935365 Fax: +1-614-3660003
Received: March 19, 2019
Peer-review started: March 19, 2019
First decision: April 30, 2019
Revised: June 13, 2019
Accepted: June 22, 2019
Article in press: June 23, 2019
Published online: July 28, 2019
Abstract

Hepatocellular carcinoma (HCC) is the most common liver malignancy worldwide and a major cause of cancer-related mortality for which liver resection is an important curative-intent treatment option. However, many patients present with advanced disease and with underlying chronic liver disease and/or cirrhosis, limiting the proportion of patients who are surgical candidates. In addition, the development of recurrent or de novo cancers following surgical resection is common. These issues have led investigators to evaluate the benefit of neoadjuvant and adjuvant treatment strategies aimed at improving resectability rates and decreasing recurrence rates. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC. In this review, we evaluate the evidence for various neoadjuvant and adjuvant therapies and discuss opportunities for future clinical and translational research.

Keywords: Hepatocellular carcinoma, Neoadjuvant therapy, Adjuvant therapy, Neoplasm recurrence, Hepatectomy, Liver cirrhosis

Core tip: Liver resection is an important curative-intent treatment option for patients with hepatocellular carcinoma (HCC). However, advanced disease, underlying chronic liver disease and/or cirrhosis, limits the proportion of patients who are surgical candidates. Recurrent disease is unfortunately common even after undergoing resection. As such, the benefits of neoadjuvant and adjuvant treatment strategies aimed at improving resectability and decreasing recurrence rates are of great interest. While high-level evidence to guide treatment decision making is lacking, recent advances in locoregional and systemic therapies, including antiviral treatment and immunotherapy, raise the prospect of novel approaches that may improve the outcomes of patients with HCC.