Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review
Hepatocellular carcinoma (HCC) usually occurs in the setting of liver cirrhosis and more rarely in a healthy liver. Its incidence has increased in the past years, especially in western countries with the rising prevalence of non-alcoholic fatty liver disease. The prognosis of advanced HCC is low. In...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-05-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/10/2357 |
| _version_ | 1797501044160200704 |
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| author | Manon Falette Puisieux Anna Pellat Antoine Assaf Claire Ginestet Catherine Brezault Marion Dhooge Philippe Soyer Romain Coriat |
| author_facet | Manon Falette Puisieux Anna Pellat Antoine Assaf Claire Ginestet Catherine Brezault Marion Dhooge Philippe Soyer Romain Coriat |
| author_sort | Manon Falette Puisieux |
| collection | DOAJ |
| description | Hepatocellular carcinoma (HCC) usually occurs in the setting of liver cirrhosis and more rarely in a healthy liver. Its incidence has increased in the past years, especially in western countries with the rising prevalence of non-alcoholic fatty liver disease. The prognosis of advanced HCC is low. In the first-line setting of advanced HCC, sorafenib, a tyrosine kinase inhibitor, was the only validated treatment for many years. In 2020, the combination of atezolizumab, an immune checkpoint inhibitor, and bevacizumab showed superiority to sorafenib alone in survival, making it the first-line recommended treatment. Regorafenib and lenvatinib, other multikinase inhibitors, were also validated in the second and first-line settings, respectively. Transarterial chemoembolization can be an alternative treatment for patients with intermediate-stage HCC and preserved liver function, including unresectable multinodular HCC without extrahepatic spread. The current challenge in advanced HCC lies in the selection of a patient for the optimal treatment, taking into account the underlying liver disease and liver function. Indeed, all trial patients present with a Child–Pugh score of A, and the optimal approach for other patients is still unclear. Furthermore, the combination of atezolizumab and bevacizumab should be considered in the absence of medical contraindication. Many trials testing immune checkpoint inhibitors in association with anti-angiogenic agents are ongoing, and primary results are promising. The landscape in advanced HCC management is undergoing profound change, and many challenges remain for optimal patient management in the years to come. This review aimed to provide an overview of current systemic treatment options for patients with advanced unresectable HCC who are not candidates for liver-directed therapy. |
| first_indexed | 2024-03-10T03:12:40Z |
| format | Article |
| id | doaj.art-6e7e3fdd5fd34f92b936ae26f1768d40 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T03:12:40Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-6e7e3fdd5fd34f92b936ae26f1768d402023-11-23T10:22:01ZengMDPI AGCancers2072-66942022-05-011410235710.3390/cancers14102357Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated ReviewManon Falette Puisieux0Anna Pellat1Antoine Assaf2Claire Ginestet3Catherine Brezault4Marion Dhooge5Philippe Soyer6Romain Coriat7Gastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, FranceGastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, FranceGastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, FranceGastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, FranceGastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, FranceGastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, FranceFaculté de Médecine, Université Paris Cité, 75006 Paris, FranceGastroenterology and Digestive Oncology Unit, Cochin Hospital, AP-HP Centre, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, FranceHepatocellular carcinoma (HCC) usually occurs in the setting of liver cirrhosis and more rarely in a healthy liver. Its incidence has increased in the past years, especially in western countries with the rising prevalence of non-alcoholic fatty liver disease. The prognosis of advanced HCC is low. In the first-line setting of advanced HCC, sorafenib, a tyrosine kinase inhibitor, was the only validated treatment for many years. In 2020, the combination of atezolizumab, an immune checkpoint inhibitor, and bevacizumab showed superiority to sorafenib alone in survival, making it the first-line recommended treatment. Regorafenib and lenvatinib, other multikinase inhibitors, were also validated in the second and first-line settings, respectively. Transarterial chemoembolization can be an alternative treatment for patients with intermediate-stage HCC and preserved liver function, including unresectable multinodular HCC without extrahepatic spread. The current challenge in advanced HCC lies in the selection of a patient for the optimal treatment, taking into account the underlying liver disease and liver function. Indeed, all trial patients present with a Child–Pugh score of A, and the optimal approach for other patients is still unclear. Furthermore, the combination of atezolizumab and bevacizumab should be considered in the absence of medical contraindication. Many trials testing immune checkpoint inhibitors in association with anti-angiogenic agents are ongoing, and primary results are promising. The landscape in advanced HCC management is undergoing profound change, and many challenges remain for optimal patient management in the years to come. This review aimed to provide an overview of current systemic treatment options for patients with advanced unresectable HCC who are not candidates for liver-directed therapy.https://www.mdpi.com/2072-6694/14/10/2357hepatocellular carcinomacirrhosisprognosistreatment |
| spellingShingle | Manon Falette Puisieux Anna Pellat Antoine Assaf Claire Ginestet Catherine Brezault Marion Dhooge Philippe Soyer Romain Coriat Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review Cancers hepatocellular carcinoma cirrhosis prognosis treatment |
| title | Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review |
| title_full | Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review |
| title_fullStr | Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review |
| title_full_unstemmed | Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review |
| title_short | Therapeutic Management of Advanced Hepatocellular Carcinoma: An Updated Review |
| title_sort | therapeutic management of advanced hepatocellular carcinoma an updated review |
| topic | hepatocellular carcinoma cirrhosis prognosis treatment |
| url | https://www.mdpi.com/2072-6694/14/10/2357 |
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