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World J Gastrointest Oncol. Sep 15, 2010; 2(9): 348-359
Published online Sep 15, 2010. doi: 10.4251/wjgo.v2.i9.348
Current approach in the treatment of hepatocellular carcinoma
Luigi Rossi, Federica Zoratto, Anselmo Papa, Francesca Iodice, Marina Minozzi, Luigi Frati, Silverio Tomao
Luigi Rossi, Federica Zoratto, Anselmo Papa, Marina Minozzi, Luigi Frati, Silverio Tomao, Department of Experimental Medicine, University of Rome “Sapienza”, Viale Regina Elena 324, 00161 Rome, Italy
Francesca Iodice, Department of Anaesthesiology, Bambino Gesù Hospital, 00100 Rome, Italy
Author contributions: Tomao S was the coordinator of the paper; Rossi L was the main author of the manuscript; Zoratto F elaborated the tables and the figures; Papa A and Minozzi M collected and studied the bibliography; Frati L investigated the role of biological targeted therapies and Iodice F corrected the language form.
Correspondence to: Silverio Tomao, Professor of Medical Oncology, Department of Experimental Medicine, University of Rome “Sapienza”, Viale Regina Elena 324, 00161 Rome, Italy. tomao.smfa@tiscali.it
Telephone: +39-6-5035826 Fax: +39-6-97251338
Received: January 12, 2010
Revised: August 24, 2010
Accepted: August 31, 2010
Published online: September 15, 2010
Abstract

Hepatocellular carcinoma (HCC) is the most common malignant hepatobiliary disease; it is responsible for about 1 million deaths per year. Risk factors include hepatitis B and C, hepatic cirrhosis, including alcohol related hepatitis, metabolic and nutritional hepatic damage. The main modality of diffusion is intrahepatic in the natural course of the disease. There are two leading types of treatment: local and systemic. Surgical resection and liver transplantation constitute the most appropriate local treatments and are considered the only real possibility for recovery. Other local approaches include: radiofrequency ablation, percutaneous ethanol ablation, hepatic endoarterial chemoembolization and intrahepatic radiotherapy (SIRT: selective internal radiation therapy). These last treatments are used to control the disease when surgery or transplantation is not achievable; in some cases they are able to prolong survival while they constitute mainly a palliative treatment. Systemic treatments include: chemotherapy, immunological and hormonal therapies and, more recently, the introduction of new specific molecular target drugs. At the moment, in this group, the only drug that has given positive results during phase III trials (SHARP study) is Sorafenib. Sorafenib represents the only primary systemic therapy that has demonstrated, unlike the other treatments previously described, an increase in survival rate in patients affected with advanced HCC. Currently, other studies are taking place that are further developing the potential of this drug. These studies, including phase III trials, are directed in order to test the activity and safety of new emerging drugs with targeted activity. Examples of these new agents are: Sunitinib, Gefitinib, Cetuximab, Bevacizumab and Erlotinib.

Keywords: Systemic treatments; Hepatocarcinogenesis; Targeted therapy; Sorafenib; Hepatocarcinoma; Local treatments