Système gastro-intestinal et digestif

Abstrait

Management of Hepatocellular Carcinoma: An Update at the Start of 2014

Gaetano Bertino, Shirin Demma, Nicoletta Bertino and Annalisa Ardiri

Background: Over the past 15 years, the incidence of hepatocellular carcinoma [HCC] has more than doubled.

Materials and methods: A search of the literature was made using cancer literature and the PubMed, Scopus, and Web of Science [WOS] database for the following keywords: “hepatocellular carcinoma”, “molecular hepatocarcinogenesis”, “RFA”, “TACE”, “TABE”, “OLTx”, “targeted therapy”, “sorafenib”, “sunitinib”, “tivantinib”, “antiangiogenic” “drugs”, “immunotherapy”.

Discussion and conclusion: For a correct and effective treatment strategy in patients with cirrhosis, it is necessary to perform a liver ultrasound twice a year. With the recent dramatic advances in diagnostic modalities, the diagnosis of HCC is primarily based on imaging. Ultrasound plays a crucial role in HCC surveillance, dynamic multiphasic multidetector-row CT [MDCT] and magnetic resonance imaging [MRI] are the standard diagnostic methods for the noninvasive diagnosis of HCC. Treatment decisions are complex and dependent upon tumor staging, presence of portal hypertension and the underlying degree of liver dysfunction, as well as local expertise, as indicated by the NCCN, APASL, AASLD, BCLC,EASL. Unfortunately, HCC is diagnosed at an advanced stage. In this case the therapeutic option is the systemic therapy. The knowledge of molecular hepatocarcinogenesis broadened the horizon for patients with advanced HCC. During the last years several molecular targeted agents have been evaluated in clinical trials in advanced HCC. In the future new therapeutic options will be represented by a blend of immunotherapy-like vaccines and T-cell modulators, supplemented by molecularly targeted inhibitors of tumor signaling pathways. Thus, it will be necessary in the future to classify HCCs into subgroups according to their genomic and proteomic profiling. The identification of the key molecules/receptors/signaling pathways and the assessment of their relevance as potential targets will be the main future challenge. Defining molecular targeted agentseffecttive for a specific subgroup will hopefully lead to personalized therapy.