Rak wątrobowokomórkowy
Leczenie

Rak wątrobowokomórkowy (HCC) stanowi 75-90% pierwotnych nowotworów wątroby i wymaga wielodyscyplinarnego podejścia terapeutycznego uwzględniającego stadium choroby, funkcję wątroby oraz stan ogólny pacjenta. W leczeniu wczesnego stadium preferowana jest resekcja chirurgiczna u pacjentów bez marskości lub z marskością klasy A wg Child-Pugh, z 5-letnim przeżyciem >60%, choć nawroty sięgają 70%. Przeszczepienie wątroby, kwalifikowane wg kryteriów mediolańskich (pojedynczy guz ≤ 5 cm lub do 3 guzów ≤ 3 cm, AFP ≤ 500 μg/L, brak inwazji naczyniowej), zapewnia 5-letnie przeżycie >75% i niskie ryzyko nawrotów (<15%). Metody ablacyjne (RFA, MWA, PEI) są skuteczne zwłaszcza w guzach ≤ 2 cm, osiągając całkowitą odpowiedź radiologiczną do 97,2%. Terapie lokoregionalne, takie jak TACE (z chemioterapeutykami: doksorubicyna, cisplatyna, mitomycyna C) i radioembolizacja (Y-90), stosowane są w stadium pośrednim (BCLC B), poprawiając przeżycie i jakość życia pacjentów.

  1. Leczenie raka wątrobowokomórkowego – przegląd opcji terapeutycznych
    1. Podejście wielodyscyplinarne
  2. Metody leczenia chirurgicznego
    1. Resekcja chirurgiczna
    2. Przeszczepienie wątroby
  3. Metody leczenia ablacyjnego
    1. Ablacja termiczna
  4. Terapie lokoregionalne
    1. Przeztętnicza chemoembolizacja (TACE)
    2. Radioembolizacja (TARE/SIRT)
  5. Radioterapia
    1. Stereotaktyczna radioterapia ciała (SBRT)
  6. Leczenie systemowe
    1. Terapia celowana
    2. Immunoterapia
    3. Terapie kombinowane
  7. Leczenie w zależności od stadium zaawansowania
    1. Wczesne stadium HCC (BCLC 0-A)
    2. Pośrednie stadium HCC (BCLC B)
    3. Zaawansowane stadium HCC (BCLC C)
    4. Schyłkowe stadium HCC (BCLC D)
  8. Leczenie nawrotów
  9. Nowe kierunki w leczeniu HCC
  10. Podsumowanie
    1. Kolejne rozdziały

Leczenie raka wątrobowokomórkowego – przegląd opcji terapeutycznych

Rak wątrobowokomórkowy (HCC) jest najczęstszym typem pierwotnego nowotworu wątroby, stanowiącym około 75-90% wszystkich przypadków pierwotnych nowotworów tego narządu. Jest to poważne schorzenie, które w zaawansowanym stadium może zagrażać życiu pacjenta. Leczenie raka wątrobowokomórkowego wymaga podejścia wielodyscyplinarnego, a wybór optymalnej metody terapeutycznej zależy od wielu czynników, w tym stadium zaawansowania nowotworu, funkcji wątroby, obecności chorób współistniejących oraz ogólnego stanu zdrowia pacjenta.12

Podejście wielodyscyplinarne

Leczenie HCC powinno być prowadzone przez zespół specjalistów składający się z hepatologów, chirurgów transplantacyjnych i wątrobowych, onkologów klinicznych, radiologów interwencyjnych oraz specjalistów opieki paliatywnej. Takie podejście jest kluczowe, aby zapewnić pacjentom optymalną opiekę i skierować ich w odpowiednim czasie na leczenie, które daje najlepsze szanse na wyleczenie lub wydłużenie życia.12

Wybór metody leczenia zależy od następujących czynników:1

  • Rozmiar, liczba i lokalizacja guzów
  • Obecność lub brak marskości wątroby
  • Ryzyko operacyjne oparte na stopniu marskości i chorobach współistniejących
  • Ogólny stan sprawności pacjenta
  • Drożność żyły wrotnej
  • Obecność lub brak przerzutów

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Metody leczenia chirurgicznego

Resekcja chirurgiczna

Resekcja chirurgiczna (częściowa hepatektomia) polega na usunięciu części wątroby zawierającej guz wraz z marginesem zdrowej tkanki. Jest to metoda preferowana u pacjentów bez marskości wątroby lub z marskością w klasie A według Child-Pugh, bez nadciśnienia wrotnego.12 Resekcja jest możliwa u stosunkowo niewielkiego odsetka pacjentów (około 15-30%) ze względu na zaawansowanie marskości wątroby.3

Pięcioletnie wskaźniki przeżycia po resekcji wynoszą ponad 60%, jednak odsetek nawrotów przekracza 70%.4 Pomimo wysokiego ryzyka nawrotu, resekcja pozostaje jedną z najskuteczniejszych metod leczenia u odpowiednio dobranych pacjentów.5

Przeszczepienie wątroby

Przeszczepienie wątroby (OLT – orthotopic liver transplantation) oferuje najlepszą szansę na wyleczenie HCC u pacjentów z marskością wątroby. Zaletą przeszczepienia jest nie tylko usunięcie nowotworu, ale także wyeliminowanie marskiej wątroby, która jest predysponowana do rozwoju nowych guzów.12

Kwalifikacja do przeszczepienia opiera się głównie na kryteriach mediolańskich, które obejmują:12

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Pacjenci spełniający kryteria mediolańskie mogą osiągnąć 5-letnie przeżycie przekraczające 75%, z odsetkiem nawrotów nieprzekraczającym 15% w ciągu 5 lat.1 Ograniczeniem tej metody jest dostępność narządów do przeszczepienia, co często powoduje długi czas oczekiwania na zabieg.2

Metody leczenia ablacyjnego

Metody ablacyjne są stosowane u pacjentów, którzy nie kwalifikują się do resekcji chirurgicznej lub przeszczepienia wątroby, a także jako terapia pomostowa przed przeszczepieniem, mająca na celu zmniejszenie ryzyka progresji guza.1

Ablacja termiczna

Do najczęściej stosowanych metod ablacji termicznej należą:12

  • Ablacja prądem o częstotliwości radiowej (RFA) – wykorzystuje prąd elektryczny o wysokiej częstotliwości do generowania ciepła, które niszczy komórki nowotworowe. Jest to najczęściej stosowana technika ablacyjna, szczególnie skuteczna w przypadku guzów o średnicy mniejszej niż 3 cm.12
  • Ablacja mikrofalowa (MWA) – wykorzystuje energię mikrofalową do wytwarzania ciepła, które niszczy komórki nowotworowe. Umożliwia ablację większych guzów w mniejszej liczbie sesji w porównaniu z RFA.1
  • Iniekcja etanolu (PEI) – polega na wstrzyknięciu wysokiego stężenia alkoholu etylowego bezpośrednio do guza, co prowadzi do martwicy komórek nowotworowych.1

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Ablacja termiczna daje najlepsze wyniki w przypadku HCC o średnicy mniejszej niż 2 cm, gdzie osiąga wskaźniki całkowitej odpowiedzi radiologicznej sięgające 97,2% po medianie obserwacji wynoszącej 31 miesięcy u pacjentów z marskością wątroby w klasie A według Child-Pugh.1

Terapie lokoregionalne

Przeztętnicza chemoembolizacja (TACE)

TACE jest jedną z najczęściej stosowanych terapii lokoregionalnych u pacjentów z HCC w stadium pośrednim (BCLC B), którzy nie kwalifikują się do leczenia chirurgicznego.1 Metoda ta wykorzystuje selektywne podanie chemioterapeutyku (najczęściej doksorubicyny, cisplatyny lub mitomycyny C) bezpośrednio do tętnicy zaopatrującej guz, a następnie embolizację naczynia, co zwiększa ekspozycję guza na lek i powoduje jego niedokrwienie.12

Wyróżnia się dwa główne rodzaje TACE:1

  • Konwencjonalna TACE (cTACE) – wykorzystuje zawiesinę lipiodolu i chemioterapeutyku oraz gąbkę żelatynową
  • TACE z wykorzystaniem cząstek uwalniających lek (DEB-TACE) – wykorzystuje mikrosfery nasączone doksorubicyną

1

TACE wykazuje korzyści w zakresie przeżycia w porównaniu z najlepszym leczeniem wspomagającym u pacjentów z HCC w stadium BCLC B, niespełniających kryteriów resekcji.1 Może być również stosowana jako terapia pomostowa przed przeszczepieniem wątroby lub w celu redukcji stadium zaawansowania guza (downstaging).2

Radioembolizacja (TARE/SIRT)

Radioembolizacja, znana również jako selektywna wewnętrzna radioterapia (SIRT), polega na podaniu do tętnicy wątrobowej mikrosfer zawierających izotop promieniotwórczy, najczęściej itr-90 (Y-90).1 Metoda ta pozwala na dostarczenie wysokiej dawki promieniowania bezpośrednio do guza, oszczędzając zdrową tkankę wątroby.2

Radioembolizacja jest stosowana u pacjentów z HCC w stadium pośrednim lub zaawansowanym (BCLC B-C), a nawet selektywnie u pacjentów w stadium BCLC D. W porównaniu z cTACE, Y-90 wiąże się z mniejszym nasileniem niepokoju, mniejszą liczbą działań niepożądanych, rzadszymi hospitalizacjami i lepszą jakością życia.12

Radioterapia

Postępy w technikach radioterapii umożliwiły bardziej precyzyjne dostarczanie wysokich dawek promieniowania do guzów wątroby, minimalizując ekspozycję zdrowej tkanki.1

Stereotaktyczna radioterapia ciała (SBRT)

SBRT jest zaawansowaną formą radioterapii wiązką zewnętrzną, która umożliwia precyzyjne dostarczanie bardzo wysokich dawek promieniowania do guzów, oszczędzając otaczające zdrowe tkanki.1 Jest alternatywą dla pacjentów z wczesnym stadium HCC, u których standardowe metody leczenia, takie jak chirurgia lub ablacja, są przeciwwskazane.1

W przypadku guzów o średnicy większej niż 4 cm, gdy lokalizacja zmiany uniemożliwia ablację termiczną, SBRT może być rozważana jako opcja terapeutyczna.1

Leczenie systemowe

Terapia systemowa jest podstawową metodą leczenia pacjentów z zaawansowanym HCC, którzy nie kwalifikują się do resekcji chirurgicznej, przeszczepienia wątroby lub lokalnej ablacji guza.1 Niestety, HCC wykazuje minimalną odpowiedź na konwencjonalną chemioterapię systemową.1

Terapia celowana

Do najważniejszych leków stosowanych w terapii celowanej HCC należą:12

  • Sorafenib (Nexavar) – pierwszy doustny inhibitor wielokinazowy, zatwierdzony przez FDA w 2007 roku do leczenia pacjentów z nieresekcyjnym HCC. Działa poprzez hamowanie angiogenezy, indukowanie apoptozy oraz hamowanie kinaz Raf.12
  • Lenvatinib (Lenvima) – inhibitor receptorów kinazy tyrozynowej, zatwierdzony przez FDA w 2018 roku jako leczenie pierwszej linii nieresekcyjnego HCC. W badaniu REFLECT wykazał nie mniejszą skuteczność niż sorafenib.12
  • Regorafenib (Stivarga) – inhibitor wielokinazowy, zatwierdzony przez FDA w 2017 roku jako leczenie drugiej linii u pacjentów z HCC, którzy byli wcześniej leczeni sorafenibem.1
  • Kabozantynib (Cabometyx) – inhibitor wielokinazowy, zatwierdzony przez FDA w 2019 roku jako leczenie drugiej linii u pacjentów z HCC, którzy byli wcześniej leczeni sorafenibem.1
  • Ramucirumab (Cyramza) – przeciwciało monoklonalne przeciwko receptorowi VEGFR-2, zatwierdzone przez FDA w 2019 roku jako leczenie drugiej linii u pacjentów z HCC, u których poziom AFP wynosi co najmniej 400 ng/ml, po wcześniejszym leczeniu sorafenibem.1

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Immunoterapia

Immunoterapia wykorzystuje układ odpornościowy pacjenta do walki z nowotworem. W ostatnich latach nastąpił znaczący postęp w leczeniu immunoterapeutycznym HCC.1

Najważniejsze leki immunoterapeutyczne stosowane w leczeniu HCC to:1

  • Niwolumab (Opdivo) – przeciwciało monoklonalne blokujące receptor PD-1, zatwierdzone przez FDA w 2017 roku do leczenia pacjentów z HCC, którzy byli wcześniej leczeni sorafenibem.1
  • Pembrolizumab (Keytruda) – przeciwciało monoklonalne blokujące receptor PD-1, zatwierdzone przez FDA dla pacjentów z HCC, którzy byli wcześniej leczeni sorafenibem.1
  • Atezolizumab (Tecentriq) – przeciwciało monoklonalne blokujące ligand PD-L1, zatwierdzone przez FDA w 2020 roku w połączeniu z bewacyzumabem do leczenia pacjentów z nieresekcyjnym lub przerzutowym HCC, którzy nie otrzymali wcześniej terapii systemowej.12
  • Durwalumab (Imfinzi) – przeciwciało monoklonalne przeciwko PD-L1, zatwierdzone przez FDA w 2022 roku w połączeniu z tremelimumabem do leczenia nieresekcyjnego HCC.1
  • Tremelimumab (Imjudo) – przeciwciało monoklonalne przeciwko CTLA-4, zatwierdzone przez FDA w 2022 roku w połączeniu z durwalumabem jako leczenie pierwszej linii nieresekcyjnego zaawansowanego HCC.1

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Terapie kombinowane

Kombinacje immunoterapii z terapią celowaną wykazują obiecujące wyniki w leczeniu zaawansowanego HCC:1

  • Atezolizumab + bewacyzumab – badanie kliniczne IMbrave150 fazy III wykazało, że ta kombinacja znacząco poprawia przeżycie całkowite i czas przeżycia wolny od progresji w porównaniu z sorafenibem u pacjentów z nieresekcyjnym lub przerzutowym HCC, którzy nie otrzymali wcześniej terapii systemowej. Na podstawie tych wyników FDA zatwierdziła tę kombinację 29 maja 2020 roku jako leczenie pierwszej linii.12
  • Tremelimumab + durwalumab – badania kliniczne fazy III wykazały skuteczność tej kombinacji jako leczenia pierwszej linii nieresekcyjnego zaawansowanego HCC.1
  • Niwolumab + ipilimumab – FDA przyspieszyła zatwierdzenie tej kombinacji dla pacjentów z HCC, którzy byli wcześniej leczeni sorafenibem.1

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Leczenie w zależności od stadium zaawansowania

Wczesne stadium HCC (BCLC 0-A)

W przypadku wczesnego stadium HCC, gdy nowotwór jest ograniczony do wątroby i nie rozprzestrzenił się, dostępne są metody leczenia potencjalnie prowadzące do wyleczenia:12

  • Resekcja chirurgiczna – preferowana u pacjentów bez marskości wątroby lub z marskością w klasie A według Child-Pugh, bez nadciśnienia wrotnego.
  • Przeszczepienie wątroby – optymalne dla pacjentów z marskością wątroby i małym HCC (spełniającym kryteria mediolańskie).
  • Ablacja (RFA, MWA) – dla pacjentów z pojedynczym guzem ≤ 2 cm, którzy nie kwalifikują się do leczenia chirurgicznego.

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Pośrednie stadium HCC (BCLC B)

Dla pacjentów z pośrednim stadium HCC, charakteryzującym się wieloogniskowym nowotworem bez inwazji naczyniowej i bez przerzutów pozawątrobowych, preferowane są terapie lokoregionalne:1

  • TACE – standardowa metoda leczenia dla pacjentów z HCC w stadium BCLC B.
  • TARE/SIRT – alternatywa dla TACE, szczególnie u pacjentów z zakrzepicą żyły wrotnej.
  • Kombinacja TACE i RFA – wykazano, że jest bardziej skuteczna niż sama RFA u pacjentów z HCC o pośredniej i dużej wielkości guza.

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Zaawansowane stadium HCC (BCLC C)

Pacjenci z zaawansowanym HCC (stadium BCLC C), u których występuje inwazja naczyniowa i/lub przerzuty pozawątrobowe, są leczeni terapią systemową:1

  • Leczenie pierwszej linii:
    • Atezolizumab + bewacyzumab – preferowana opcja dla pacjentów z marskością wątroby w klasie A według Child-Pugh i stanem sprawności ECOG 0-1.12
    • Tremelimumab + durwalumab – alternatywa dla pacjentów, którzy nie mogą otrzymać bewacyzumabu.1
    • Lenvatinib lub sorafenib – alternatywne opcje pierwszej linii.1
  • Leczenie drugiej linii (po niepowodzeniu leczenia pierwszej linii):
    • Regorafenib, kabozantynib lub ramucirumab (u pacjentów z AFP ≥ 400 ng/ml) – po niepowodzeniu leczenia sorafenibem.1
    • Niwolumab z ipilimumabem lub pembrolizumab – alternatywne opcje drugiej linii.1

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Schyłkowe stadium HCC (BCLC D)

Pacjenci ze schyłkowym stadium HCC (BCLC D), charakteryzującym się bardzo złym stanem ogólnym (ECOG > 2) i/lub zaawansowaną niewydolnością wątroby (klasa C według Child-Pugh), są zazwyczaj leczeni objawowo w ramach opieki paliatywnej.1

  • Opieka paliatywna – skupia się na łagodzeniu bólu, poprawie odżywienia i wsparciu psychologicznym.
  • Radioterapia paliatywna – może być stosowana w celu złagodzenia bólu u pacjentów z przerzutami do kości.

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Leczenie nawrotów

HCC może nawrócić po leczeniu. Wskaźniki nawrotów po resekcji chirurgicznej sięgają 70% w ciągu 5 lat.1 Leczenie nawrotów zależy od wielu czynników, w tym miejsca nawrotu, wcześniejszych terapii i funkcji wątroby.1

Opcje leczenia nawrotów HCC obejmują:1

  • Ponowną resekcję – u pacjentów z zachowaną funkcją wątroby i ograniczonym nawrotem.
  • Przeszczepienie wątroby – jeśli spełnione są kryteria mediolańskie.
  • Leczenie ablacyjne – dla małych nawrotowych guzów.
  • TACE – dla nawrotów wieloogniskowych.
  • Terapię systemową – dla nawrotów z przerzutami pozawątrobowymi.

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Nowe kierunki w leczeniu HCC

Badania kliniczne koncentrują się na opracowaniu nowych terapii dla HCC, które mogłyby poprawić wyniki leczenia pacjentów z tym nowotworem:1

  • Nowe kombinacje immunoterapii – badania nad nowymi kombinacjami inhibitorów punktów kontrolnych immunologicznych, które mogą zwiększyć odpowiedź na leczenie.1
  • Kombinacje TACE z immunoterapią – badania LEAP-012 i EMERALD-1 wykazały, że dodanie immunoterapii i terapii celowanej do TACE poprawia przeżycie wolne od progresji u pacjentów z nieresekcyjnym HCC.12
  • Terapia adjuwantowa – badanie IMbrave050 fazy III wykazało skuteczność atezolizumabu w połączeniu z bewacyzumabem jako terapii adjuwantowej u pacjentów z HCC po resekcji chirurgicznej lub ablacji.1
  • Histotrypsia – nowa technologia zatwierdzona w 2023 roku przez FDA do leczenia guzów wątroby, wykorzystująca ultradźwięki do niszczenia tkanki nowotworowej.1

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Podsumowanie

Leczenie raka wątrobowokomórkowego wymaga podejścia wielodyscyplinarnego, a wybór optymalnej metody terapeutycznej zależy od stadium zaawansowania nowotworu, funkcji wątroby i ogólnego stanu zdrowia pacjenta. W leczeniu wczesnego stadium HCC preferowane są metody chirurgiczne, takie jak resekcja i przeszczepienie wątroby, które dają szansę na wyleczenie. Dla pacjentów, którzy nie kwalifikują się do leczenia chirurgicznego, dostępne są techniki ablacyjne i terapie lokoregionalne. Pacjenci z zaawansowanym HCC są leczeni terapią systemową, w tym immunoterapią i terapią celowaną, które wykazują obiecujące wyniki w wydłużaniu przeżycia.12

Postępy w leczeniu systemowym, szczególnie wprowadzenie immunoterapii i nowych terapii celowanych, znacząco zmieniły perspektywy dla pacjentów z zaawansowanym HCC. Kombinacja atezolizumabu z bewacyzumabem stała się nowym standardem leczenia pierwszej linii, a nowe badania nad kombinacjami immunoterapii i terapii celowanych oraz leczeniem adjuwantowym po resekcji lub ablacji mogą dalej poprawić wyniki leczenia pacjentów z tym trudnym do leczenia nowotworem.12

Kolejne rozdziały

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  1. 09.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    Management of hepatocellular carcinoma (HCC) is best performed in a multidisciplinary setting. Patients should be cooperatively managed by hepatologists, transplant and hepatobiliary surgeons, medical oncologists, interventional radiologists, and palliative care specialists. Specifically, this is crucial to ensure that patients who are candidates for liver transplantation are referred in a timely manner, while their tumors are within the Milan criteria. […] Treatment options for HCC depend on the following: size, number, and location of tumors; presence or absence of cirrhosis; operative risk based on extent of cirrhosis and comorbid diseases; overall performance status; portal vein patency; presence or absence of metastatic disease. […] Surgical resection and liver transplantation provide the only chances of cure but have limited applicability. The main prognostic factors for resectability are tumor size and liver function. Only about 5% of hepatocellular carcinoma patients are suitable for transplantation; these patients may have a 5-year survival of greater than 75% with tumor recurrence rates as low as 15% at 5 years.
  • #1 Current and future treatments for hepatocellular carcinoma
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4515831/
    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. […] 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. […] Liver transplantation eliminates HCC and therefore is the best therapeutic approach for the treatment of HCC. […] The Milan criteria are used for selecting and screening patients with HCC for transplantation. […] The most successful treatment for non-cirrhotic patients with appropriately staged HCC is hepatic resection.
  • #1 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    In view of the absence of effective chemotherapy and the insensitivity of HCC to radiotherapy, complete tumor extirpation represents the only opportunity for a long-term cure. Resection of the tumor by partial hepatectomy can be accomplished in a limited number of patients (generally 15-30%) in most Western series due to the degree of underlying cirrhosis. […] Compared with resection for HCC, orthotopic liver transplantation (OLT) offers several potential advantages. Complete hepatectomy eliminates the possibility of local recurrence at the resection margin and, moreover, removes the cirrhotic liver, which is clearly predisposed to tumor formation. […] The application of OLT to HCC has also been limited by access to deceased donor organs. […] Ablative procedures, including ethanol injection, RFA, and cryotherapy, can be performed percutaneously, laparoscopically, or via an open surgical approach.
  • #1 Hepatocellular Carcinoma – Hepatic and Biliary Disorders – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/liver-masses-and-granulomas/hepatocellular-carcinoma
    Transplantation if tumors are within the Milan criteria (1 tumor 5 cm or 3 tumors 3 cm without vascular invasion and alpha-fetoprotein 500 mcg/L). […] Surgical resection in selected patients. […] Sometimes, liver-directed ablative therapy and systemic chemotherapy/immunotherapy. […] Treatment of hepatocellular carcinoma (HCC) depends on its stage (1) and the underlying severity of liver disease. […] The Milan criteria (single tumors 5 cm or 3 tumors that are all 3 cm and that are limited to the liver, without microvascular invasion, and if AFP is 500 mcg/L) are used to identify patients with HCC who are good candidates for liver transplantation. […] Transplantation for HCC can be curative and appears to result in as good a prognosis as liver transplantation performed for noncancerous disorders.
  • #1 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    Sorafenib is an oral agent that has antiangiogenic, proapoptotic, and Raf-kinase inhibitory properties. In 2007, it was approved by the FDA for use in patients with unresectable HCC. […] In patients with recurrence and preserved liver function, repeat resection may be indicated. […] Curative treatment of patients with HCC who are not candidates for resection or OLT is limited. However, local ablative therapies can be used either as a bridge to transplant by reducing the risk of tumor progression or as a palliative procedure to extend disease-free survival. […] For most patients, treatment options other than palliative care are limited. For patients with Child-Pugh class C cirrhosis and contraindications for transplantation, any intervention has the potential to result in progressive hepatic decompensation.
  • #1 Current treatments for hepatocellular carcinoma | JHC
    https://www.dovepress.com/expert-insights-on-current-treatments-for-hepatocellular-carcinoma-cli-peer-reviewed-fulltext-article-JHC
    We herein review different clinical and molecular treatment modalities related to the treatment of HCC, as well as provide insights into future directions for HCC treatment. […] Hepatic resection is an option for patients with early-stage HCC disease. Many patients are not candidates for resection, however, due to underlying liver dysfunction or locally advanced disease. […] Liver transplant is therapeutic option for individuals with early-stage HCC that offers the best chance for optimal long-term outcomes. […] Ablation involves inducing tumor necrosis either with thermal energy or cryoablation to the lesion. […] Given that most of the blood supply to liver tumors is derived from the hepatic artery, embolization naturally evolved as a therapeutic modality for intermediate to large size HCC (57 cm) that is unresectable and not amenable to ablation techniques.
  • #1 Diagnosis and treatment of hepatocellular carcinoma: An update
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4381163/
    Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. […] Currently available treatments include tumor resection, liver transplant, sorafenib and loco-regional therapies (alcoholization, radiofrequency ablation, chemoembolization). […] Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib. […] The most commonly used ablation methods are percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA). […] RFA is currently considered the safest ablation method and yields better results in BCLC A patients.
  • #1 The Treatment Path in Hepatocellular Carcinoma – Hematology & Oncology
    https://www.hematologyandoncology.net/supplements/the-treatment-path-in-hepatocellular-carcinoma/
    In contrast, liver transplant is associated with a very low risk for recurrence in selected patients who meet the Milan criteria (1 mass ≤5 cm, or ≤3 masses each with a diameter ≤3 cm). However, few patients qualify or are eligible for liver transplant owing to the strict criteria in place to ensure that the available organs are distributed to those most likely to have excellent outcomes. Among patients with HCC who meet the Milan criteria for orthotopic liver transplant, the 4-year overall survival rate following liver transplant is 85%. […] The most common type of localized ablation therapy is radiofrequency ablation, which is considered the optimal treatment for patients with early-stage HCC who are not eligible for surgical resection or transplant. In randomized clinical studies, radiofrequency ablation has been more effective than the previous standard of ethanol injection for patients with small tumors (2 to 3 cm in diameter). The short-term outcomes with radiofrequency ablation are excellent, with a 2-year overall survival rate of 98%. However, long-term outcomes reflect the noncurative nature of radiofrequency ablation; 5-year recurrence rates approach 70%. Microwave ablation is a newer method of ablation that offers the additional advantage of ablating larger tumors in fewer sessions.
  • #1 Local Therapies for Unresectable Primary Hepatocellular Carcinoma: Comparative Effectiveness Review | Effective Health Care (EHC) Program
    https://effectivehealthcare.ahrq.gov/products/liver-cancer-therapy/research-protocol
    Several liver-directed therapies have been developed to treat patients with HCC. The liver-directed therapies are broken into two groups based on the treatment intent (curative or palliative) and include: […] Ablation […] – Percutaneous ethanol injection (PEI) involves the injection of a high concentration of ethyl alcohol directly into liver tumors with ultrasound or x-ray guidance. […] – In radiofrequency ablation (RFA), an alternating current is generated between two or more electrodes in the radiofrequency range to produce heat without causing muscle contractions. […] – Microwave ablation (MWA) uses high-frequency electromagnetic radiation to create heat by exciting water molecules. […] Radiotherapy […] – Stereotactic body radiation therapy (SBRT) is a type of external-beam radiation therapy that delivers with high targeting accuracy a high dose of radiation to an extracranial target within the body.
  • #1 Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    https://www.mdpi.com/1422-0067/20/6/1465
    Locoregional therapies are nowadays applied for a wide range of curative and palliative indications, including their repeat application, their combination with resection, bridging the waiting time to transplantation and down-staging advanced tumors to fulfil criteria of resection or transplantation. […] The most widely employed ablative technique is RFA, the principle of which relies on ion agitation and heat generated due to the electrical impedance of the tissue (Joule effect). […] The RFA treatment yields the best results in HCCs smaller than 2 cm, where sustained, local complete radiological response rates of 97.2% after a median follow-up of 31 months have been documented in patients with Child A cirrhosis. […] In patients with BCLC 0 and A tumors, RFA is a valid treatment strategy, especially if the patient is not eligible for surgical resection.
  • #1 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    The most commonly offered therapy is transcatheter arterial chemoembolization (TACE). TACE is performed by an interventional radiologist who selectively cannulates the feeding artery to the tumor and delivers high local doses of chemotherapeutic agents, including doxorubicin, cisplatin, or mitomycin C. […] Stereotactic body radiation therapy (SBRT) is an advanced form of external beam radiotherapy that provides precise delivery of very high doses of radiation to tumors, while sparing surrounding healthy tissue. SBRT is an alternative for patients with early-stage HCC in whom standard treatments, such as surgery or ablation, are contraindicated. […] Systemic therapy remains the mainstay of treatment for patients with advanced HCC who are not candidates for surgical resection, liver transplantation, or localized tumor ablation. Unfortunately, HCC is minimally responsive to systemic chemotherapy.
  • #1 Current Treatment Methods in Hepatocellular Carcinoma
    https://www.mdpi.com/2072-6694/16/23/4059
    High-frequency alternating current is used in RFA to eliminate solid tumour tissue. […] Currently, it is evaluated in combination with TACE. […] Transarterial therapies like TACE, transarterial embolization (TAE), and transarterial radioembolization (TARE) are widely used treatment modalities for HCC. […] TACE techniques encompass conventional TACE (cTACE) and drug-eluting beads, which use TACE (DEB-TACE). […] The innovative balloon-occluded TACE (B-TACE) technique involves using the microballoon catheter to infuse the chemotherapeutic emulsion with lipiodol followed by gelatine corpuscles under the occluded artery. […] The results from a meta-analysis of eight trials showed that the combination of TACE and RFA was more effective than RFA alone in HCC patients with intermediate and large-size tumours and patients at younger ages.
  • #1 Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    https://www.mdpi.com/1422-0067/20/6/1465
    The principle of TACE relies on targeting the arterial hypervascularization of HCC. Tumor necrosis is achieved by embolization of the arterial blood supply with either a suspension of lipiodol and a chemotherapeutic agent and gelatin sponge or with drug-eluding beads loaded with doxorubicin. […] While TACE results in an inferior OS than LR in resectable lesions, several RCTs have provided evidence of an improved survival after TACE compared to best supportive care in BCLC B patients beyond resection criteria, making TACE an integral part of treatment in this cohort. […] Radioembolization is most commonly performed with Y-90-coated glass- or resin microspheres. […] Y-90 can be performed across the stages BCLC A-C and even selectively in BCLC D patients and compares favorably with the reported survival expectations, but the evidence in this patient cohort is limited.
  • #1 FF #348 Treatment Options for Hepatocellular Carcinoma | Palliative Care Network of Wisconsin
    https://www.mypcnow.org/fast-fact/treatment-options-for-hepatocellular-carcinoma/
    The goal of this therapy is to improve QoL, prolong survival, and in some cases, downstage the tumor in hopes of making the mass surgically resectable. […] Studies have demonstrated survival benefits as well as improvements in patient-reported outcomes including QoL, pain, function, and emotional well-being with cTACE, DEB-TACE, and Y-90 in patients with BCLC B or C disease. […] Compared to cTACE, Y-90 was associated with less nervousness, less side effects, less hospitalizations, and an improved QoL. […] Postembolization syndrome characterized by a resolving, 3-day course of pain, nausea, and vomiting can occur with cTACE and DEB-TACE. […] Many with advanced HCC are faced with the complicated decision of whether to pursue systemic targeted therapy, most usually oral sorafenib. Although sorafenib is associated with a significant improvement in median survival for patients with BCLC Stage C, several trade-offs need to be considered.
  • #1 6 Innovative Liver Cancer Treatment Options | MD Anderson Cancer Center
    https://www.mdanderson.org/cancer-types/liver-cancer/liver-cancer-treatment.html
    New radiation therapy techniques allow MD Anderson doctors to target liver tumors more precisely. […] Radiation therapy options include: […] Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. […] Immunotherapy recruits the patients own immune system in the fight against cancer. […] Targeted therapies work by stopping or slowing the growth or spread of cancer. […] Histotripsy is a new technology that was approved in 2023 by the Food and Drug Administration (FDA) for the treatment of liver tumors. […] Histotripsy is only approved to treat liver cancers. However, it can be any type of liver tumor, whether it is a primary tumor (i.e. a tumor that started in the liver, such as hepatocellular carcinoma or cholangiocarcinoma) or another type of cancer that metastasized, or spread, to the liver.
  • #1 Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    https://www.mdpi.com/1422-0067/20/6/1465
    The application of high intensity ultrasound energy leads both to thermal ablation, as well as to non-thermal effects in the context of cavitation and mechanical tissue disruption due to boiling bubbles. […] SBRT is mostly applied in HCC > 4 cm if the location of the lesion prohibits thermal ablation and can be considered for HCC recurrence after ablation. […] The most prevalent driver mutations in HCC affect the TERT promoter, TP53 and the Wnt/β-catenin signaling pathway and are not yet amenable to routine therapeutic targeting. […] The PD-1 inhibitor Nivolumab may significantly shape future treatment perspectives for advanced HCC. […] In conclusion, significant advances have been made in the study and development of surgical, loco-regional and systemic treatment modalities for HCC. Nevertheless, in the face of the global disease burden and the limited survival in advanced stages, further research is fundamental to improve the prognosis of patients with HCC.
  • #1 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    However, there is also no apparent benefit to chemotherapy in the adjuvant setting following resection or radiofrequency ablation (RFA). Since systemic chemotherapy has questionable benefits compared with risks (eg, toxicities), targeted therapy and immunotherapy have been the main treatments for advanced, unresectable HCC. […] First-line combination therapy with tremelimumab (Imjudo) and durvalumab (Imfinzi) was approved by the US Food and Drug Administration (FDA) in 2022 for the treatment for unresectable advanced HCC. […] In 2020, the FDA approved atezolizumab in combination with bevacizumab for systemic treatment nave patients with unresectable or metastatic HCC. […] In 2018, the FDA approved lenvatinib, a vascular endothelial growth factor (VEGF) inhibitor, for first-line treatment of unresectable HCC.
  • #1 Targeted therapy for hepatocellular carcinoma | Signal Transduction and Targeted Therapy
    https://www.nature.com/articles/s41392-020-00264-x
    The last 3 years have seen the emergence of promising targeted therapies for the treatment of hepatocellular carcinoma (HCC). […] Sorafenib has been the mainstay of treatment for a decade and newer modalities were ineffective and did not confer any increased therapeutic benefit until the introduction of lenvatinib which was approved based on its non-inferiority to sorafenib. […] The subsequent success of regorafenib in HCC patients who progress on sorafenib treatment heralded a new era of second-line treatment and was quickly followed by ramucirumab, cabozantinib, and the most influential, immune checkpoint inhibitors (ICIs). […] Work continues to develop additional novel therapeutic agents which could potentially augment the presently available options and understand the underlying mechanisms responsible for drug resistance, with the goal of improving the survival of patients with HCC.
  • #1 Targeted therapy for hepatocellular carcinoma | Signal Transduction and Targeted Therapy
    https://www.nature.com/articles/s41392-020-00264-x
    Regorafenib provided survival benefit regardless of the rate of disease progression during prior sorafenib treatment or since the last sorafenib dose. […] Cabozantinib is another small molecule inhibitor of the tyrosine kinases which are implicated in the progression of HCC and the acquired resistance to sorafenib. […] Ramucirumab is a fully human recombinant IgG1 monoclonal antibody targeting the VEGF2 receptor. […] ICIs stand as the mainstream of immunotherapy. […] Despite abovementioned targeted drugs, novel agents have been continuously under development. […] The combination of bevacizumab and erlotinib has been extensively evaluated as first- or second-line in advanced HCCs, but unfortunately the heterogeneous nature of the results precludes firm conclusions and recommendations.
  • #1 Recent advances in systemic therapy for hepatocellular carcinoma | Biomarker Research | Full Text
    https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-021-00350-4
    To date, systemic therapy for advanced HCC includes molecular targeted therapy, immune checkpoint inhibitors, or a combination of both. […] Sorafenib is the first and only systemic drug approved by the U.S. Food and Drug Administration (FDA) as standard treatment for advanced HCC between 2007 and 2016. […] Based on these data, sorafenib was approved by the U.S. FDA in November 2007 for advanced HCC as first-line standard treatment. […] Based on the REFLECT results, the U.S. FDA approved lenvatinib for the first-line treatment of patients with advanced HCC on August 16, 2018. […] On April 27, 2017, the U.S. FDA expanded the indication for regorafenib as a second-line treatment for advanced HCC patients previously treated with sorafenib. […] Based on these results, on January 14, 2019, the U.S. FDA approved cabozantinib for patients with HCC who had previously received sorafenib treatment.
  • #1 Recent advances in systemic therapy for hepatocellular carcinoma | Biomarker Research | Full Text
    https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-021-00350-4
    Based on these results, on May 10, 2019, the U.S. FDA authorized ramucirumab as a second-line treatment for HCC patients whose AFP was no less than 400 ng/mL. […] The success of anti-cytotoxic T lymphocyte associated antigen 4 (CTLA-4) antibodies in blocking immune checkpoints in advanced melanoma patients offers hope for immunotherapy of tumors. […] Nivolumab, a monoclonal antibody, blocks the PD-1 signaling pathway and restores the anti-tumor immune activity. […] Based on the ORR and the durable objective responses, on September 22, 2017, the U.S. FDA accelerated the approval of nivolumab to treat HCC patients who were first treated with sorafenib. […] Atezolizumab + bevacizumab showed a tolerable safety profile and efficacy for treating unresectable HCC patients in GO30140. […] On May 29, 2020, the U.S. FDA approved atezolizumab in combination with bevacizumab as a first-line treatment for advanced HCC patients based on the safety and efficacy revealed in IMbrave 150.
  • #1 Hepatocellular Carcinoma (HCC) Medication: Antineoplastics, Tyrosine Kinase Inhibitor, Antineoplastics, VEGF Inhibitor, PD-1/PD-L1 Inhibitors, Antineoplastics, Anti-CTLA4 Antibodies
    https://emedicine.medscape.com/article/197319-medication
    Few systemic options exist for patients with unresectable hepatocellular carcinoma (uHCC). The combination of tremelimumab plus durvalumab is the first dual checkpoint combination approved showing improved efficacy compared with monotherapy. Sorafenib monotherapy or durvalumab monotherapy are indicated for patients with unresectable or advanced HCC. Other recent options are regorafenib, nivolumab, lenvatinib, pembrolizumab, cabozantinib, and ramucirumab. […] Sorafenib is a tyrosine kinase inhibitor. It is indicated for unresectable hepatocellular carcinoma. […] Regorafenib is a tyrosine kinase inhibitor. It is indicated for hepatocellular carcinoma in patients who have been previously treated with sorafenib. […] Cabozantinib is an inhibitor of multiple tyrosine kinases, including RET, MET, and VEGFR-2. It is indicated for HCC in patients previously treated with sorafenib.
  • #1 What’s new in treating hepatocellular carcinoma, the most common liver cancer? | MD Anderson Cancer Center
    https://www.mdanderson.org/cancerwise/what-is-new-in-treating-hepatocellular-carcinoma–the-most-common-liver-cancer.h00-159617856.html
    Hepatocellular carcinoma is the most common type of primary liver cancer. […] Since hepatocellular carcinoma is diagnosed in people with existing liver disease, only 15% to 20% of patients can receive surgery or a liver transplant. […] Thanks to new research, there is good news in the treatment of hepatocellular carcinoma. […] Hepatocellular carcinoma tumors have a lot of immune cells in the tumor. These immune cells are not active, but treatment with immunotherapy can activate them against the tumor. […] One of the first treatments for treating advanced hepatocellular carcinoma was a targeted therapy drug called sorafenib. […] The IMBrave150 Phase III clinical trial combined an immune checkpoint inhibitor called atezolizumab with bevacizumab, a targeted anti-EGFR therapy that starves tumors by preventing new blood vessels from growing.
  • #1 Hepatocellular Carcinoma (HCC) Medication: Antineoplastics, Tyrosine Kinase Inhibitor, Antineoplastics, VEGF Inhibitor, PD-1/PD-L1 Inhibitors, Antineoplastics, Anti-CTLA4 Antibodies
    https://emedicine.medscape.com/article/197319-medication
    Lenvatinib is a receptor tyrosine kinase (RTK) inhibitor that inhibits the kinase activities of VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4). It is indicated for first-line treatment of unresectable HCC. […] Ramucirumab is indicated as monotherapy for hepatocellular carcinoma (HCC) in patients with alpha fetoprotein (AFP) of 400 ng/mL or higher who have been previously treated with sorafenib. […] Bevacizumab is indicated, in combination with atezolizumab, for unresectable or metastatic HCC who have not received prior systemic therapy. […] Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody. FDA granted accelerated approval to combination of nivolumab and ipilimumab for HCC in patients previously treated with sorafenib. […] Pembrolizumab is indicated for patients with hepatocellular carcinoma (HCC) secondary to hepatitis B who have received prior systemic therapy other than a PD-1/PD-L1-containing regimen. […] Atezolizumab is indicated, in combination with bevacizumab, for unresectable or metastatic HCC in patients who have not received prior systemic therapy. […] Durvalumab is indicated in combination with tremelimumab for unresectable hepatocellular carcinoma (uHCC).
  • #1 Recent advances in systemic therapy for hepatocellular carcinoma | Biomarker Research | Full Text
    https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-021-00350-4
    A meta-analysis of 14 clinical trials conducted by Sonbol et al. showed that atezolizumab + bevacizumab was superior in the first-line setting compared to sorafenib, lenvatinib, and nivolumab. […] According to these guidelines, atezolizumab + bevacizumab is the standard treatment for most patients with advanced HCC in Child-Pugh grade A and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 01.
  • #1 Hepatocellular Carcinoma – Hepatic and Biliary Disorders – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/liver-masses-and-granulomas/hepatocellular-carcinoma
    The 2020 American Society of Clinical Oncology guidelines and the 2023 American Association and Study of Liver Disease HCC guidelines recommend use of atezolizumab and bevacizumab or tremelimumab plus durvalumab as first-line therapy for patients with Child-Pugh class A liver disease and Eastern Cooperative Oncology Group (ECOG) status 01. […] Because of an increased risk of bleeding with atezolizumab and bevacizumab, patients should have variceal ligation prior to initiation of therapy. […] Immunotherapy is not recommended in patients with HCC recurrence post transplant because stimulation of the host immune system may lead to higher rates of rejection. […] A new regimen combines tremelimumab, an anticytotoxic T-lymphocyte protein 4 (or „CTLA-4”) plus durvalumab (an anti-PD-L1). […] This combination is available for patients with unresectable HCC and is often used as an alternative for patients with Child-Pugh class A cirrhosis and excellent performance status who cannot receive bevacizumab.
  • #1 Systemic treatment for advanced unresectable and metastatic hepatocellular carcinoma – UpToDate
    https://www.uptodate.com/contents/systemic-treatment-for-advanced-hepatocellular-carcinoma
    Systemic treatment for advanced unresectable and metastatic hepatocellular carcinoma […] Treatment options include surgical therapies (ie, resection and liver transplantation), liver-directed therapies (ie, radiofrequency ablation, microwave ablation, hepatic arterial embolization, radiation therapy [RT]), and/or systemic therapy. […] This topic will discuss systemic treatment approaches for patients with advanced unresectable or metastatic HCC for whom liver transplantation and liver-directed therapy are not appropriate. […] Initial therapy for patients with Child-Pugh class A cirrhosis includes Atezolizumab plus bevacizumab and Tremelimumab plus durvalumab. […] Other regimens include Lenvatinib and Sorafenib. […] Second-line therapy for patients with Child-Pugh class A cirrhosis may involve Lenvatinib, Nivolumab plus ipilimumab, and Pembrolizumab. […] Patients with Child-Pugh class B cirrhosis may receive immunotherapy, antiangiogenic agents, and chemotherapy. […] This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient.
  • #1 Treatment of Liver Cancer, by Stage | American Cancer Society
    https://www.cancer.org/cancer/types/liver-cancer/treating/by-stage.html
    For people whose liver is functioning well enough, initial treatment options might include: The immunotherapy drug atezolizumab (Tecentriq) plus the targeted drug bevacizumab (Avastin). […] If these drugs are no longer working (or if they can’t be given for some reason), other options might include: Other targeted drugs such as regorafenib (Stivarga), cabozantinib (Cabometyx), or ramucirumab (Cyramza). […] Treatment of liver cancer that returns after initial therapy depends on many factors, including where it comes back, which treatment(s) a person has had before, and how well the liver is functioning. […] People with resectable cancer that recurs in the liver might be eligible for further surgery or local treatments like ablation, embolization, or radiation therapy.
  • #1 liver cancer
    https://www.astrazeneca.com/our-therapy-areas/oncology/Liver-cancer.html
    Treatment for intermediate-stage liver cancer (Stage B) and advanced-stage liver cancer (Stage C) may involve: Systemic therapy is used in Stage B patients who are ineligible for other treatments or progressed on other therapies, as well as Stage C patients. There is a critical unmet medical need for new treatments that can treat patients with advanced stages of HCC. Ongoing research has revealed immuno-oncology therapies show promise in this challenging setting. […] Treatment for end-stage liver cancer (Stage D) may involve: Palliative support is used in Stage D patients for the management of pain, nutrition and psychological support. Radiotherapy can be used to alleviate pain in patients with bone metastasis and relieve symptoms from pulmonary or lymph node metastases. Nutritional interventions are tailored to individual cases, with a focus on dietary counselling and, when necessary, artificial nutrition, to slow down nutritional deprivation, prevent dehydration and improve overall quality of life. Psychosocial and spiritual aspects should be integrated into the care management of terminal HCC patients.
  • #1 Current Treatment Methods in Hepatocellular Carcinoma
    https://www.mdpi.com/2072-6694/16/23/4059
    Advanced surgical techniques and instrumentation have improved the surgical treatment of HCC; however, the best candidates for resection are patients with very early or early-stage HCC. […] Careful evaluation of the liver for signs and symptoms related to portal hypertension is necessary, which is crucial in determining the relationship of the tumour to the main vasculature of the liver. […] Resection is associated with a high recurrence rate, which ranges between 40% and 80% within 5 years of surgical resection. […] For patients with early recurrence, palliative therapies are used, while patients with late recurrence may benefit from re-resection. […] Patients with cirrhosis are referred for liver transplantation (LT), provided they meet the Milan criteria (MiC). […] Liver transplantation gives a better oncological result than surgical resection because it not only removes all pre-cancerous and cancerous lesions in the liver but also treats coexisting liver disease.
  • #1 HCC liver cancer – Liver Cancer UK
    https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/
    Unfortunately HCC can come back after treatment. Doctors call this recurrent cancer. It may come back in the liver or elsewhere in the body. If in the liver, you may have: more surgery to remove the cancer; a liver transplant; treatment to destroy the tumours (ablation); TACE – localised chemo into the liver.
  • #1 Combined therapy makes headway for liver cancer: Newsroom – UT Southwestern, Dallas, Texas
    https://www.utsouthwestern.edu/newsroom/articles/year-2024/may-combined-therapy-live-cancer.html
    Adding another drug to immunotherapy increased response rate for hepatocellular carcinoma patients in phase 2 trial, UTSW reports […] A drug that targets a protein known as phosphatidylserine boosted the response rate for hepatocellular carcinoma (HCC) patients receiving immunotherapy without compromising their safety, according to results of a phase two clinical trial conducted by UT Southwestern Medical Center. […] This study shows the promise of improving the success of cancer immunotherapies by targeting other immunomodulating proteins simultaneously, said study leader David Hsieh, M.D. […] More recently, immunotherapies treatments that spur the immune system to fight tumors have emerged as the most effective treatments for HCC patients. […] These results suggest that adding agents that target phosphatidylserine to immunotherapy regimens could increase the likelihood of response in HCC and potentially other cancers in which this protein might affect anti-cancer immunity.
  • #1 TACE Plus Drug Combination Effective in Liver Cancer – NCI
    https://www.cancer.gov/news-events/cancer-currents-blog/2025/liver-cancer-tace-plus-targeted-and-immunotherapy
    Some people with liver cancer are treated with a procedure called transarterial chemoembolization, or TACE, in which doctors use a catheter to deliver chemotherapy directly to the liver. […] How doctors treat a form of liver cancer called intermediate-stage hepatocellular carcinoma (HCC) is likely to change, based on updated findings from two large clinical trials. […] TACE has long been the standard treatment for intermediate-stage HCC, which is when the cancer hasn’t spread beyond the liver but can’t be removed surgically because of issues like cirrhosis or the size or location of the tumors. […] One trial, called LEAP-012, tested TACE in combination with the immunotherapy drug pembrolizumab (Keytruda) and the angiogenesis inhibitor lenvatinib (Lenvima). […] The other trial, called EMERALD-1, tested TACE plus the immunotherapy drug durvalumab (Imfinzi) and the angiogenesis inhibitor bevacizumab.
  • #1 Current Treatment Methods in Hepatocellular Carcinoma
    https://www.mdpi.com/2072-6694/16/23/4059
    Sorafenib is an oral multikinase inhibitor of the serine-threonine kinases Raf-1 and B-Raf, as well as the receptor TKI of vascular endothelial growth factor receptors (VEGFRs)-1, 2, and 3, and platelet-derived growth factor receptor beta (PDGFR-beta). […] The efficacy of lenvatinib treatment is under investigation. […] The retrospective analysis of patients with non-viral advanced HCC treated with atezolizumab plus bevacizumab, lenvatinib, or sorafenib demonstrated that OS and PFS were significantly longer in the group of patients treated with lenvatinib versus atezolizumab plus bevacizumab. […] The phase III IMbrave050 trial demonstrated an efficacious adjuvant therapy using atezolizumab plus bevacizumab for HCC patients who have undergone surgical resection or ablation. […] The results of the study indicate that there is a significant discrepancy between radiological and pathological responses to immunotherapy, suggesting that current imaging methods are insufficient to detect pathologic complete response (PCR). […] The problem with high rates of recurrence after ablation or resection is a new challenge for HCC treatment.
  • #1 Current treatments for hepatocellular carcinoma | JHC
    https://www.dovepress.com/expert-insights-on-current-treatments-for-hepatocellular-carcinoma-cli-peer-reviewed-fulltext-article-JHC
    Nivolumab monotherapy has been demonstrated to improve outcomes of patients with advanced HCC. […] Overall, treatment options for all stages of HCC have expanded exponentially in the past few years. […] Multiple advances have been made over the last decade regarding treatment of HCC, especially advanced disease. Resection and transplantation remain as cornerstone curative-intent treatment options. For patients who are not candidates for curative-intent therapy, exciting progress has been made in molecular and cellular approaches to systemic therapy for HCC including immunotherapies and tyrosine kinase inhibitors.
  • #1 Hepatocellular carcinoma: treatment options | JHC
    https://www.dovepress.com/hepatocellular-carcinoma-an-overview-of-the-changing-landscape-of-trea-peer-reviewed-fulltext-article-JHC
    Currently, according to the presented evidence, it seems that HCC management can be vaguely divided between the management of resectable and non resectable tumors. In the first case, surgery can be preceded or followed by various therapeutic modalities including TACE and TARE (sorafenib and ICIs are also being assessed in phase II trials) as neoadjuvant interventions or systematic therapy, hepatic arterial infusion therapy, TACE, radiolabeled lipiodol, ablation and radiotherapy postoperatively. As far as non-resectable tumors are concerned, TKIs and immunotherapy have now replaced chemotherapy and hormone therapy. Particularly, the novel doublet of atezolizumab plus bevacizumab is indicated as a first-line option for patients (Child-Pugh A, ECOG PS 01) without a history of co-infection with hepatitis B and hepatitis C, autoimmune disease, or bleeding predisposition.
  • #2 Current treatments for hepatocellular carcinoma | JHC
    https://www.dovepress.com/expert-insights-on-current-treatments-for-hepatocellular-carcinoma-cli-peer-reviewed-fulltext-article-JHC
    Hepatocellular carcinoma (HCC) is a primary liver tumor that typically occurs in the setting of chronic liver disease/cirrhosis. Treatment modalities for HCC have evolved and given the variety of treatment options, a multi-disciplinary approach requiring input from surgical, medical, and radiation oncology, hepatology, and interventional radiology is necessary. […] Resection and transplantation remain as cornerstone curative-intent treatment options. For patients who are not candidates for curative-intent therapy, exciting progress has been made in molecular and cellular approaches to systemic therapy for HCC including immunotherapies and tyrosine kinase inhibitors. […] While the main therapeutic modality for early-stage disease remains resection, multimodal immunotherapy has emerged as first-line treatment for advanced disease.
  • #2 What’s new in treating hepatocellular carcinoma, the most common liver cancer? | MD Anderson Cancer Center
    https://www.mdanderson.org/cancerwise/what-is-new-in-treating-hepatocellular-carcinoma–the-most-common-liver-cancer.h00-159617856.html
    On May 29, 2020, the FDA approved this drug combination for people with liver cancer that has spread or that cant be treated with surgery based on the study results. […] The results show that atezolizumab plus bevacizumab is the first treatment given after surgery to demonstrate that patients lived longer without their cancer returning compared to those in active surveillance. […] These trial results indicate that this drug combination given after surgery has the potential to set a new standard of care for hepatocellular carcinoma treatment. […] If you are diagnosed with hepatocellular carcinoma, you need to be treated by a multidisciplinary team like we have here at MD Anderson.
  • #2 6 Innovative Liver Cancer Treatment Options | MD Anderson Cancer Center
    https://www.mdanderson.org/cancer-types/liver-cancer/liver-cancer-treatment.html
    MD Anderson offers innovative treatments provided by some of the worlds leading liver cancer experts. Your personalized treatment plan will depend on: […] Treatments that aim to cure liver cancer are usually only used for early stage cancers. If the tumor is found at a later stage, treatment other than surgery may be used. Your team will determine the most appropriate therapy for you. […] Surgery offers patients with early stage disease the best chance for successful treatment. If all the cancer can be removed, the possibility of successful treatment is higher. […] The main types of surgery for liver cancer are: […] Hepatectomy: The part of the liver with the tumor is removed. […] Liver transplant: The diseased liver is removed and replaced with a healthy liver from a donor. […] MD Anderson’s Interventional Oncology Clinic performs these treatments for liver cancer and liver metastases.
  • #2 Current and future treatments for hepatocellular carcinoma
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4515831/
    Liver resection is an established treatment for HCC with significantly decreased surgical mortality. […] Percutaneous ablative techniques have several foreseeable advantages over surgical resection. […] TACE is a treatment modality employed for the management of patients with HCC who are deemed poor candidates for curative treatments. […] Sorafenib is the first oral multi kinase inhibitor approved for the treatment of unresectable HCC by FDA in 2007 based on the results of two large multicenters randomized controlled trials. […] In many cases, advanced stage HCC is beyond the scope of curative treatments thus directing disease management to a more palliative approach aimed at increasing survival and improving the quality of life for patients. […] The recent advances in understanding the pathogenesis of HCC have led to the successful development and approval of Sorafenib, currently the only drug shown to increase survival in randomized controlled trials. […] A comprehensive review such offers an opportunity for clinicians and patients to better understand, compare and contrast established, cutting edge and future treatment modalities.
  • #2 Diagnosis and treatment of hepatocellular carcinoma: An update
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4381163/
    In patients with unresectable tumors, the most feasible surgical option is orthotopic liver transplant (OLT) in conjunction with adjuvant therapies such as TACE or percutaneous ablation. […] The combination of chemoembolization and radiofrequency ablation has proven to better control tumor growth in lesions between 3 and 5 cm. […] The molecular pathways involved in the pathogenesis of HCC are manifold but there are few therapeutic modalities specifically directed to these molecular targets that have yielded relevant results; the most studied and validated is the use of sorafenib. […] Sorafenib is currently considered first-line systemic therapy due its effectiveness and toxicity profile.
  • #2 Hepatocellular Carcinoma – Hepatic and Biliary Disorders – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/liver-masses-and-granulomas/hepatocellular-carcinoma
    Transplantation if tumors are within the Milan criteria (1 tumor 5 cm or 3 tumors 3 cm without vascular invasion and alpha-fetoprotein 500 mcg/L). […] Surgical resection in selected patients. […] Sometimes, liver-directed ablative therapy and systemic chemotherapy/immunotherapy. […] Treatment of hepatocellular carcinoma (HCC) depends on its stage (1) and the underlying severity of liver disease. […] The Milan criteria (single tumors 5 cm or 3 tumors that are all 3 cm and that are limited to the liver, without microvascular invasion, and if AFP is 500 mcg/L) are used to identify patients with HCC who are good candidates for liver transplantation. […] Transplantation for HCC can be curative and appears to result in as good a prognosis as liver transplantation performed for noncancerous disorders.
  • #2 Current and future treatments for hepatocellular carcinoma
    https://pmc.ncbi.nlm.nih.gov/articles/PMC4515831/
    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. […] 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. […] Liver transplantation eliminates HCC and therefore is the best therapeutic approach for the treatment of HCC. […] The Milan criteria are used for selecting and screening patients with HCC for transplantation. […] The most successful treatment for non-cirrhotic patients with appropriately staged HCC is hepatic resection.
  • #2 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    In view of the absence of effective chemotherapy and the insensitivity of HCC to radiotherapy, complete tumor extirpation represents the only opportunity for a long-term cure. Resection of the tumor by partial hepatectomy can be accomplished in a limited number of patients (generally 15-30%) in most Western series due to the degree of underlying cirrhosis. […] Compared with resection for HCC, orthotopic liver transplantation (OLT) offers several potential advantages. Complete hepatectomy eliminates the possibility of local recurrence at the resection margin and, moreover, removes the cirrhotic liver, which is clearly predisposed to tumor formation. […] The application of OLT to HCC has also been limited by access to deceased donor organs. […] Ablative procedures, including ethanol injection, RFA, and cryotherapy, can be performed percutaneously, laparoscopically, or via an open surgical approach.
  • #2 Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    https://www.mdpi.com/1422-0067/20/6/1465
    Long-term survival rates after LR are only marginally inferior to the ones after transplantation, and are usually determined by intrahepatic tumor recurrence, which occurs in half of the cases at 3 years after liver resection or ablation. […] Reasoning that LR, if technically attainable, reduces the stress on the limited donor organ pool and does not require long waiting times with potential treatment dropout, surgical resection is nowadays often performed in selected patients eligible for transplantation, reserving OLT for HCC patients whose severely impaired liver function precludes resection. […] Locoregional therapies for HCC include a broad spectrum of techniques such as TACE, trans-arterial radioembolization with Yttrium-90 (Y-90), radiofrequency (RFA), microwave (MWA) and cryoablation, irreversible electroporation (IRE), percutaneous ethanol injection (PEI), high-intensity focused ultrasound (HIFU) and stereotactic body radiotherapy (SBRT).
  • #2 Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    https://www.mdpi.com/1422-0067/20/6/1465
    Locoregional therapies are nowadays applied for a wide range of curative and palliative indications, including their repeat application, their combination with resection, bridging the waiting time to transplantation and down-staging advanced tumors to fulfil criteria of resection or transplantation. […] The most widely employed ablative technique is RFA, the principle of which relies on ion agitation and heat generated due to the electrical impedance of the tissue (Joule effect). […] The RFA treatment yields the best results in HCCs smaller than 2 cm, where sustained, local complete radiological response rates of 97.2% after a median follow-up of 31 months have been documented in patients with Child A cirrhosis. […] In patients with BCLC 0 and A tumors, RFA is a valid treatment strategy, especially if the patient is not eligible for surgical resection.
  • #2 Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    https://www.mdpi.com/1422-0067/20/6/1465
    The principle of TACE relies on targeting the arterial hypervascularization of HCC. Tumor necrosis is achieved by embolization of the arterial blood supply with either a suspension of lipiodol and a chemotherapeutic agent and gelatin sponge or with drug-eluding beads loaded with doxorubicin. […] While TACE results in an inferior OS than LR in resectable lesions, several RCTs have provided evidence of an improved survival after TACE compared to best supportive care in BCLC B patients beyond resection criteria, making TACE an integral part of treatment in this cohort. […] Radioembolization is most commonly performed with Y-90-coated glass- or resin microspheres. […] Y-90 can be performed across the stages BCLC A-C and even selectively in BCLC D patients and compares favorably with the reported survival expectations, but the evidence in this patient cohort is limited.
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  • #2 Targeted therapy for hepatocellular carcinoma | Signal Transduction and Targeted Therapy
    https://www.nature.com/articles/s41392-020-00264-x
    Due to the high recurrence rates following hepatectomy for HCC, approaches to adjuvant therapy has been extensively investigated although previous attempts, including the use of anti-viral agents, have been largely unsuccessful. […] Based on the palliative use and success of sorafenib its potential in the adjuvant setting was investigated and improved survivals following surgery anticipated. […] Lenvatinib was approved for the first-line therapy in advanced HCC following the results of the REFLECT trial, a randomized phase III non-inferiority trial published by Kudo et al. […] Lenvatinib pharmacokinetics in HCC is affected by body weight and a sufficient dose (relative dose intensity, RDI) is required to achieve a good therapeutic effect and consequently improved outcomes and prognosis are associated with the preservation of liver function which reduces the number of patients who need to discontinue their treatment.
  • #2 Targeted therapy for hepatocellular carcinoma | Signal Transduction and Targeted Therapy
    https://www.nature.com/articles/s41392-020-00264-x
    The success of SHARP and Asia-Pacific trial promoted the approval of sorafenib as first-line targeted therapy for advanced HCC, ushering in the era of systemic treatment. […] The clinical benefit of sorafenib however remains modest and the complex molecular pathogenesis of HCC stimulated the investigation of combinations of sorafenib with other molecular targeting drugs. […] Since sorafenib and TACE are both recommended therapies for advanced HCC, it is reasonable to expect that their combined use would confer benefits when compared with monotherapy. […] The acceptance of sorafenib as the standard to which other newer agents and non-surgical interventions are compared has resulted in studies comparing its use as monotherapy with TACE plus external beam radiotherapy and TACE plus intensity-modulated radiotherapy combined with sorafenib.
  • #2 Hepatocellular Carcinoma (HCC) Medication: Antineoplastics, Tyrosine Kinase Inhibitor, Antineoplastics, VEGF Inhibitor, PD-1/PD-L1 Inhibitors, Antineoplastics, Anti-CTLA4 Antibodies
    https://emedicine.medscape.com/article/197319-medication
    Lenvatinib is a receptor tyrosine kinase (RTK) inhibitor that inhibits the kinase activities of VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4). It is indicated for first-line treatment of unresectable HCC. […] Ramucirumab is indicated as monotherapy for hepatocellular carcinoma (HCC) in patients with alpha fetoprotein (AFP) of 400 ng/mL or higher who have been previously treated with sorafenib. […] Bevacizumab is indicated, in combination with atezolizumab, for unresectable or metastatic HCC who have not received prior systemic therapy. […] Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody. FDA granted accelerated approval to combination of nivolumab and ipilimumab for HCC in patients previously treated with sorafenib. […] Pembrolizumab is indicated for patients with hepatocellular carcinoma (HCC) secondary to hepatitis B who have received prior systemic therapy other than a PD-1/PD-L1-containing regimen. […] Atezolizumab is indicated, in combination with bevacizumab, for unresectable or metastatic HCC in patients who have not received prior systemic therapy. […] Durvalumab is indicated in combination with tremelimumab for unresectable hepatocellular carcinoma (uHCC).
  • #2 Recent advances in systemic therapy for hepatocellular carcinoma | Biomarker Research | Full Text
    https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-021-00350-4
    Based on these results, on May 10, 2019, the U.S. FDA authorized ramucirumab as a second-line treatment for HCC patients whose AFP was no less than 400 ng/mL. […] The success of anti-cytotoxic T lymphocyte associated antigen 4 (CTLA-4) antibodies in blocking immune checkpoints in advanced melanoma patients offers hope for immunotherapy of tumors. […] Nivolumab, a monoclonal antibody, blocks the PD-1 signaling pathway and restores the anti-tumor immune activity. […] Based on the ORR and the durable objective responses, on September 22, 2017, the U.S. FDA accelerated the approval of nivolumab to treat HCC patients who were first treated with sorafenib. […] Atezolizumab + bevacizumab showed a tolerable safety profile and efficacy for treating unresectable HCC patients in GO30140. […] On May 29, 2020, the U.S. FDA approved atezolizumab in combination with bevacizumab as a first-line treatment for advanced HCC patients based on the safety and efficacy revealed in IMbrave 150.
  • #2 Hepatocellular Carcinoma – Hepatic and Biliary Disorders – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/liver-masses-and-granulomas/hepatocellular-carcinoma
    The 2020 American Society of Clinical Oncology guidelines and the 2023 American Association and Study of Liver Disease HCC guidelines recommend use of atezolizumab and bevacizumab or tremelimumab plus durvalumab as first-line therapy for patients with Child-Pugh class A liver disease and Eastern Cooperative Oncology Group (ECOG) status 01. […] Because of an increased risk of bleeding with atezolizumab and bevacizumab, patients should have variceal ligation prior to initiation of therapy. […] Immunotherapy is not recommended in patients with HCC recurrence post transplant because stimulation of the host immune system may lead to higher rates of rejection. […] A new regimen combines tremelimumab, an anticytotoxic T-lymphocyte protein 4 (or „CTLA-4”) plus durvalumab (an anti-PD-L1). […] This combination is available for patients with unresectable HCC and is often used as an alternative for patients with Child-Pugh class A cirrhosis and excellent performance status who cannot receive bevacizumab.
  • #2 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    Sorafenib is an oral agent that has antiangiogenic, proapoptotic, and Raf-kinase inhibitory properties. In 2007, it was approved by the FDA for use in patients with unresectable HCC. […] In patients with recurrence and preserved liver function, repeat resection may be indicated. […] Curative treatment of patients with HCC who are not candidates for resection or OLT is limited. However, local ablative therapies can be used either as a bridge to transplant by reducing the risk of tumor progression or as a palliative procedure to extend disease-free survival. […] For most patients, treatment options other than palliative care are limited. For patients with Child-Pugh class C cirrhosis and contraindications for transplantation, any intervention has the potential to result in progressive hepatic decompensation.
  • #2 HCC liver cancer – Liver Cancer UK
    https://livercanceruk.org/liver-cancer-information/types-of-liver-cancer/hcc/
    Unfortunately HCC can come back after treatment. Doctors call this recurrent cancer. It may come back in the liver or elsewhere in the body. If in the liver, you may have: more surgery to remove the cancer; a liver transplant; treatment to destroy the tumours (ablation); TACE – localised chemo into the liver.
  • #2 TACE Plus Drug Combination Effective in Liver Cancer – NCI
    https://www.cancer.gov/news-events/cancer-currents-blog/2025/liver-cancer-tace-plus-targeted-and-immunotherapy
    Both studies had similar results: Patients treated with TACE plus the two-drug combination lived longer without their cancer coming back or getting worse, a measure called progression-free survival, than those treated only with TACE. […] In LEAP-012, the median progression free survival was 14.6 months versus 10 months, respectively, and in EMERALD-1 it was 15 months versus 8.2 months. […] Nevertheless, he said he expects that oncologists will begin offering more people with intermediate-stage HCC one of these options. […] From a patient perspective, the improvement in progression-free survival is meaningful, Dr. Greten said. […] Despite many attempts, researchers haven’t been able to improve the outcomes of patients with intermediate-stage HCC, explained Angela Lamarca, M.D., Ph.D., a liver cancer researcher at Fundacion Jimenez Diaz University Hospital in Spain.
  • #2 TACE Plus Drug Combination Effective in Liver Cancer – NCI
    https://www.cancer.gov/news-events/cancer-currents-blog/2025/liver-cancer-tace-plus-targeted-and-immunotherapy
    Some people with liver cancer are treated with a procedure called transarterial chemoembolization, or TACE, in which doctors use a catheter to deliver chemotherapy directly to the liver. […] How doctors treat a form of liver cancer called intermediate-stage hepatocellular carcinoma (HCC) is likely to change, based on updated findings from two large clinical trials. […] TACE has long been the standard treatment for intermediate-stage HCC, which is when the cancer hasn’t spread beyond the liver but can’t be removed surgically because of issues like cirrhosis or the size or location of the tumors. […] One trial, called LEAP-012, tested TACE in combination with the immunotherapy drug pembrolizumab (Keytruda) and the angiogenesis inhibitor lenvatinib (Lenvima). […] The other trial, called EMERALD-1, tested TACE plus the immunotherapy drug durvalumab (Imfinzi) and the angiogenesis inhibitor bevacizumab.
  • #2 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    Management of hepatocellular carcinoma (HCC) is best performed in a multidisciplinary setting. Patients should be cooperatively managed by hepatologists, transplant and hepatobiliary surgeons, medical oncologists, interventional radiologists, and palliative care specialists. Specifically, this is crucial to ensure that patients who are candidates for liver transplantation are referred in a timely manner, while their tumors are within the Milan criteria. […] Treatment options for HCC depend on the following: size, number, and location of tumors; presence or absence of cirrhosis; operative risk based on extent of cirrhosis and comorbid diseases; overall performance status; portal vein patency; presence or absence of metastatic disease. […] Surgical resection and liver transplantation provide the only chances of cure but have limited applicability. The main prognostic factors for resectability are tumor size and liver function. Only about 5% of hepatocellular carcinoma patients are suitable for transplantation; these patients may have a 5-year survival of greater than 75% with tumor recurrence rates as low as 15% at 5 years.
  • #2 Hepatocellular carcinoma: signaling pathways and therapeutic advances | Signal Transduction and Targeted Therapy
    https://www.nature.com/articles/s41392-024-02075-w
    Recently, the strategy also showed significantly improved recurrence-free survival (RFS) in early stage HCC. […] The development of targeted therapy and treatment regimens over time in HCC. […] The current focus is on the development of more potent and safer agents that target immune checkpoint pathways and angiogenesis-related pathways, such as the vascular endothelial growth factor receptor (VEGFR), transforming growth factor (TGF-) signaling, among others. […] Exploring epigenetic modifications and dysregulated pathways, including MAPK, PI3K-AKT, and Janus Kinases (JAKs)/signal transducers and activators of transcription (STATs) pathway, can be beneficial in identifying drug combinations that are both safer and more effective. […] This review summarizes essential signaling pathways including cellular signaling pathways and immune-related signaling pathways, discusses current potential therapeutic targets in HCC, and presents preclinical animal models alongside ongoing or completed clinical studies on systemic therapy, aiming to provide a prospective outlook on precision treatment for HCC in the future.
  • #3 Hepatocellular Carcinoma (HCC) Treatment & Management: Approach Considerations, Nonoperative Therapy, Surgical Therapy
    https://emedicine.medscape.com/article/197319-treatment
    In view of the absence of effective chemotherapy and the insensitivity of HCC to radiotherapy, complete tumor extirpation represents the only opportunity for a long-term cure. Resection of the tumor by partial hepatectomy can be accomplished in a limited number of patients (generally 15-30%) in most Western series due to the degree of underlying cirrhosis. […] Compared with resection for HCC, orthotopic liver transplantation (OLT) offers several potential advantages. Complete hepatectomy eliminates the possibility of local recurrence at the resection margin and, moreover, removes the cirrhotic liver, which is clearly predisposed to tumor formation. […] The application of OLT to HCC has also been limited by access to deceased donor organs. […] Ablative procedures, including ethanol injection, RFA, and cryotherapy, can be performed percutaneously, laparoscopically, or via an open surgical approach.
  • #4 Hepatocellular carcinoma – Wikipedia
    https://en.wikipedia.org/wiki/Hepatocellular_carcinoma
    Palliative intention: for more advanced disease, including spread of cancer beyond the liver or in persons who may not tolerate surgery, treatment intended to decrease symptoms of disease and maximize duration of survival. […] Loco-regional therapy (also referred to as liver-directed therapy) refers to any one of several minimally-invasive treatment techniques to focally target HCC within the liver. These procedures are alternatives to surgery, and may be considered in combination with other strategies, such as a later liver transplantation. […] Surgical resection of HCC tumors is usually the preferred treatment for BCLC stage 0 or A disease. […] Surgical resection is associated with a greater than 60% survival rate at 5 years and a recurrence rate greater than 70%. […] Liver transplantation, replacing the diseased liver with a cadaveric or a living donor liver, plays an increasing role in treatment of HCC.
  • #5 Treatment Strategies for Hepatocellular Carcinoma—A Multidisciplinary Approach
    https://www.mdpi.com/1422-0067/20/6/1465
    Long-term survival rates after LR are only marginally inferior to the ones after transplantation, and are usually determined by intrahepatic tumor recurrence, which occurs in half of the cases at 3 years after liver resection or ablation. […] Reasoning that LR, if technically attainable, reduces the stress on the limited donor organ pool and does not require long waiting times with potential treatment dropout, surgical resection is nowadays often performed in selected patients eligible for transplantation, reserving OLT for HCC patients whose severely impaired liver function precludes resection. […] Locoregional therapies for HCC include a broad spectrum of techniques such as TACE, trans-arterial radioembolization with Yttrium-90 (Y-90), radiofrequency (RFA), microwave (MWA) and cryoablation, irreversible electroporation (IRE), percutaneous ethanol injection (PEI), high-intensity focused ultrasound (HIFU) and stereotactic body radiotherapy (SBRT).

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