A Review and Update of Treatment Options and Controversies in the Management of Hepatocellular Carcinoma

Dhir, Mashaal; Melin, Alyson A.; Douaiher, Jeffrey; Lin, Chi; Zhen, Weining; Hussain, Shahid; Geschwind, Jean François H.; Doyle, Maria B. Majella; Abou‐Alfa, Ghassan K.; Are, Chandrakanth

doi:10.1097/sla.0000000000001556

Cited by 240 publications

(187 citation statements)

References 73 publications

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“…Treatment options for HCC have widened and improved over time to include surgical, locoregional, and systemic therapies [4], and staging algorithms including the Barcelona Clinical Liver Cancer (BCLC) system have facilitated a rational treatment allocation process. Despite increasing efforts addressed at harmonizing management decisions, there is recognized geographical variation in the provision of radical and palliative treatments in HCC where regional preferences and the availability of each treatment modality among the treating multidisciplinary tumour board affect outcomes [5,6].…”

Section: Introductionmentioning

confidence: 99%

Treatment Stage Migration Maximizes Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib: An Observational Study

et al. 2017

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Background: Level I evidence supports the use of sorafenib in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma, where heterogeneity in efficacy exists due to varying clinicopathologic features of the disease. Aim: We evaluated whether prior treatment with curative or locoregional therapies influences sorafenib-specific survival. Methods: From a prospective data set of 785 consecutive patients from international specialist centres, 264 patients (34%) were treatment naïve (TN) and 521 (66%) were pre-treated (PT), most frequently with transarterial chemoembolization (n = 413; 79%). The primary endpoint was overall survival (OS) from sorafenib initiation with prognostic factors tested on uni- and multivariate analyses. Results: Median OS for the entire cohort was 9 months; the median sorafenib duration was 2.8 months, with discontinuation being secondary to progression (n = 454; 58%) or toxicity (n = 149; 19%). PT patients had significantly longer OS than TN patients (10.5 vs. 6.6 months; p < 0.001). Compared to TN patients, PT patients had a better Child-Pugh (CP) class (CP A: 57 vs. 47%; p < 0.001) and a lower BCLC stage (BCLC A-B, 40 vs. 30%; p = 0.007). PT status preserved an independent prognostic role (p = 0.002) following adjustment for BCLC stage, α-fetoprotein, CP class, aetiology, and post-sorafenib treatment status. PT patients were more likely to receive further anticancer treatment after sorafenib (31 vs. 9%; p < 0.001). Conclusion: Patients receiving sorafenib after having failed curative or locoregional therapies survive longer and are more likely to receive further treatment after sorafenib. This suggests an incremental benefit to OS from sequential exposure to multiple lines of therapy, justifying treatment stage migration in eligible patients.

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Section: Introductionmentioning

confidence: 99%

Treatment Stage Migration Maximizes Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib: An Observational Study

et al. 2017

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“…However, it has many side effects. For example, the postoperative five-year survival rate is low and the quality of life of patients is not improved [2,3,4].…”

Section: Introductionmentioning

confidence: 99%

Apoptosis for HepG2 Cells Induced by Low-frequency and Low-power Ultrasound with Hydroxyapatite

Chen¹,

Xu²,

Wang³

et al. 2017

Proceedings of the 2017 International Conference on Material Science, Energy and Environmental Engineering (MSEEE 2017)

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Abstract. The exploration of the apoptosis for HepG2 cells induced by low-frequency and low-power ultrasound combined with hydroxyapatite, provides data base for future clinical treatment. In this research, we selected the HepG2 cells model. The experiences were divided into four groups: control group, ultrasound group, hydroxyapatite group, and ultrasound + hydroxyapatite group. Ultrasound group and control group replaced the normal culture medium, hydroxyapatite group and ultrasound + hydroxyapatite group replaced culture medium containing hydroxyapatite. The control group and hydroxyapatite group were not treated, while ultrasound group and ultrasound + hydroxyapatite group were treated by ultrasound with different parameters (f= 20 kHz; P=0.1, 0.2, 0.3w/cm 2 ; t=30, 60, 90, 120, 150, 180s; T= 0, 12, 24, 48, 72h). MTT test and flow cytometry detected the inhibitory rate of the cells, cell apoptosis and cell cycle. MTT experiment results show that ultrasound with different parameters stimulates the cell model, which leads to the difference of the inhibition rate of cell growth. Among them, the inhibition rate of cell growth reached the top value (71.726±0.677)% with the treatment of f=20 kHz, P =0.2w/cm 2 ,t=90s,T=48h. There was a statistical significance compared with the control group, ultrasound group, and hydroxyapatite group (P<0.05).Under such condition, the apoptosis rate of HepG2 cells was a statistically significant change compared with the control group, ultrasound group, and hydroxyapatite group (P<0.05). During the cell cycle assay, the ultrasonic + hydroxyapatite group also showed obvious G2/M phase block. Low frequency and low-power ultrasound with Hydroxyapatite induced the apoptosis in human HepG2 cells.

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“…The management of HCC is improving with the expansion of resection criteria, due to progresses in surgical technique, advanced locoregional therapy, advent of targeted systemic therapies, newer techniques of radiation therapy, and the possibility of liver transplantation (3). Orthotopic liver transplantation (OLT) is the ideal treatment for patients with HCC and cirrhosis, because it can cure not only HCC but also underlying hepatic disease.…”

Section: Introductionmentioning

confidence: 99%

Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

Ogawa¹,

Takada²

2016

Transl. Gastroenterol. Hepatol.

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With the scarcity of deceased donor liver grafts, living donor liver transplantation (LDLT) is gaining popularity as an alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, as the evidence of cases of LDLT accumulates, several authors have reported higher HCC recurrence rates after LDLT. The suggested reasons for the higher recurrence rates following LDLT are related to the small-for-size graft in LDLT, surgical procedures that are specific to LDLT, and the fast-track to LDLT. Fast-tracking to LDLT may not allow sufficient time for evaluation of the biological aggressiveness of tumors, which may result in high recurrence rates due to inclusion of patients with more inherently aggressive tumors. Actually, some studies that reported higher recurrence rates with LDLT included a larger number of cases of HCC with microvascular invasion or poorly differentiated HCC. In order to exclude biologically aggressive HCC preoperatively, selection criteria incorporating tumor markers, such as alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP), as well as morphological tumor number and size have been proposed. With more reliable selection criteria incorporating biological markers to eliminate biologically aggressive HCC, LDLT can be a viable treatment option for patients with HCC, providing similar recurrence rates as those achieved with DDLT.

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A Review and Update of Treatment Options and Controversies in the Management of Hepatocellular Carcinoma

Cited by 240 publications

References 73 publications

Treatment Stage Migration Maximizes Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib: An Observational Study

Treatment Stage Migration Maximizes Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib: An Observational Study

Apoptosis for HepG2 Cells Induced by Low-frequency and Low-power Ultrasound with Hydroxyapatite

Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

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