Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.673
Peer-review started: August 28, 2014
First decision: November 27, 2014
Revised: December 17, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 8, 2015
The incidence of hepatocellular carcinoma (HCC) is increasing, and it is currently the second leading cause of cancer-related death worldwide. Potentially curative treatment options for HCC include resection, transplantation, and percutaneous ablation, whereas palliative treatments include trans-arterial chemoembolization (TACE), radioembolization, and systemic treatments. Due to the diversity of available treatment options and patients’ presentations, a multidisciplinary team should decide clinical management of HCC, according to tumor characteristics and stage of liver disease. Potentially curative treatments are suitable for very-early- and early-stage HCC. However, the vast majority of HCC patients are diagnosed in later stages, where the tumor characteristics or progress of liver disease prevent curative interventions. For patients with intermediate-stage HCC, TACE and radioembolization improve survival and are being evaluated in addition to potentially curative therapies or with systemic targeted therapy. There is currently no effective systemic chemotherapy, immunologic, or hormonal therapy for HCC, and sorafenib is the only approved molecular-targeted treatment for advanced HCC. Other targeted agents are under investigation; trials comparing new agents in combination with sorafenib are ongoing. Combinations of systemic targeted therapies with local treatments are being evaluated for further improvements in HCC patient outcomes. This article provides an updated and comprehensive overview of the current standards and trends in the treatment of HCC.
Core tip: This article reviews the available treatment options for hepatocellular carcinoma. The recent clinical trials of molecular-targeted therapies, as single agents or in combination with other treatments, are reviewed, and some future study directions are addressed. The importance of a multidisciplinary approach to management is highlighted.