This article discusses the results of clinical trials and the perspectives for perioperative systemic therapy for liver cancer, as well as the effectiveness of combination with locoregional methods. Special attention is paid to first and second line hepatocellular carcinoma therapy, as already approved in the Russian Federation (multikinase inhibitors, monoclonal antibodies to the vascular endothelial growth factor receptor, checkpoint inhibitors), as well as ongoing clinical trials. Promising combinations of immunotherapy with multikinase and (or) angiogenic inhibitors, potential predictors of the effectiveness of immunotherapy for hepatocellular carcinoma, as well as the features of therapy after orthotopic liver transplantation and against the background of non-compensated liver cirrhosis, are considered.
Clinical cases of brain metastases from hepatocellular carcinoma (HCC) after orthotopical liver transplantation (OLT) are presented. Predictors of brain metastases from HCC after OLT, the choice of post-transplantation therapy, brain CT after OLT for early metastatic detection are discussed. Increased overall survival rate due to the effective local approach (surgery and/or x-ray therapy) is also reported.
It is reported a unique clinical case of administration of crizotinib in a 14-year-old patient with ALK-positive metastatic cholangiocarcinoma and congenital viral hepatitis B. Driver oncogenic mutations potentially responsive to targeted therapy as well as possible ways to prolong crizotinib short-term effect are discussed.
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