Treatment Option for Hepatocellular Carcinoma

Hepatocellular carcinoma is fairly common worldwide; secondary to Hepatitis B, and less common in the United States where the majority of cases are secondary to Hepatitis C and alcoholic liver cirrhosis.

Back in the 1990’s liver transplantation was the only therapeutic option potentially curable in selected patients. Currently the therapeutic options are numerous and diversified.

Over the last twenty years interventional radiology has taken a major role in curing or palliating hepatocellular carcinoma. Chemoembolization is the introduction in the hepatic artery of therapeutic substances. The most recent developments in order to improve the delivery of chemotherapeutic agents to tumors, is the use of (DEB’s) drug eluting beads. The beads facilitate the delivery of doxorubicin to the tumor. The beads slowly elute the doxorubicin over a week post embolization. Radioactive substances can also be infused through the hepatic artery like Yttrium-90. With radio frequency ablation, heat is utilized to kill the tumor and a zone surrounding the tumor. The probe utilizes a 5 centimeter kill zone. Eternal beam radiation therapy can be utilized as well. Advanced radiation technology has improved on the precision of delivery of the therapy. Currently we have image guided radiation therapy as well as stereotactic radiation therapy that have decreased the margins of normal tissue being affected markedly decreasing toxicity.

Systemic therapeutic options for hepatocellular carcinoma or HCC have also markedly improved over the last decade. Systemic chemotherapy notoriously was not very effective for HCC. Most recently with the development of targeted therapies the systemic options have improved survival with less toxicity.

Sorafenib is a multikinase inhibitor which has doubled survival in resectable HCC. It is oral and its major side effects are rash diarrhea. Sunitinib is another oral tyrosine kinase inhibitor is also effective for HCC which has as major side effects cytopenias.

Avastin is an antiangiogenic intravenous drug that also led to doubling in survival. Hypertension has been the leading side effect. EGFR inhibitors as well as m-tor inhibitors are being evaluated as well with promising results. Certainly the outlook for a very difficult cancer to treat has markedly improved.