Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 18, 2015; 7(17): 2053-2057
Published online Aug 18, 2015. doi: 10.4254/wjh.v7.i17.2053
Second line systemic therapies for hepatocellular carcinoma: Reasons for the failure
Marcello Maida, Massimo Iavarone, Maurizio Raineri, Calogero Cammà, Giuseppe Cabibbo
Marcello Maida, Calogero Cammà, Giuseppe Cabibbo, Section of Gastroenterology, DIBIMIS, University of Palermo, 90127 Palermo, Italy
Massimo Iavarone, IRCCS Maggiore Hospital, University of Milan, 20162 Milan, Italy
Maurizio Raineri, Section of Intensive Care and Emergency, DIBIMED, University of Palermo, 90127 Palermo, Italy
Author contributions: All authors contributed to writing the paper and had full control over preparation of manuscript; all authors approved the final draft manuscript.
Conflict-of-interest statement: We declare that we have no proprietary, financial, professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled “Second line systemic therapies for hepatocellular carcinoma: Reasons for the failure”.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marcello Maida, MD, Section of Gastroenterology, DIBIMIS, University of Palermo, P.zza delle Cliniche 2, 90127 Palermo, Italy. marcello.maida@unipa.it
Telephone: +39-09-16552145 Fax: +39-09-16552156
Received: February 23, 2015
Peer-review started: February 25, 2015
First decision: June 3, 2015
Revised: June 22, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: August 18, 2015
Processing time: 178 Days and 18.9 Hours
Abstract

Hepatocellular carcinoma (HCC) is the main cause of death in patients with cirrhosis, with an increasing incidence worldwide. Sorafenib is the choice therapy for advanced HCC. Over time several randomized phase III trials have been performed testing sunitinib, brivanib, linifanib and other molecules in head-to-head comparison with Sorafenib as first-line treatment for advanced-stage HCC, but none of these has so far been registered in this setting. Moreover, another feared vacuum arises from the absence of molecules registered as second-line therapy for patients who have failed Sorafenib, representing an urgent unmet medical need. To date all molecules tested as second-line therapies for advanced hepatocellular carcinoma, failed to demonstrate an increased survival compared to placebo. What are the possible reasons for the failure? What we should expect in the near future?

Keywords: Systemic therapies; Sorafenib; Barcelona Clinic Liver Cancer; Hepatocellular carcinoma

Core tip: Hepatocellular carcinoma (HCC) is the main cause of death in patients with cirrhosis with an increasing incidence worldwide. Sorafenib is the choice therapy for advanced HCC. Since then no other molecule has been registered as first-line therapy in this setting and one more vacuum arises from the absence of molecules registered as second-line therapy for patients who have failed Sorafenib. What are the reasons and what we should expect in the near future?