Carr BI.
Liver Cancer Center, Starzl Transplantation Institute, University of Pittsburgh Medical Center, BST, E 1552, 200 Lothrop Street, Pittsburgh, Pennsylvania 15213, USA. carrbi@upmc.edu
The hallmarks of hepatocellular
carcinoma (HCC) are that it is identified clinically at an advanced stage and
usually together with cirrhosis. Surgical resection has been considered the
optimal treatment approach, but only a small proportion of patients qualify
for surgery, and there is a high rate of recurrence. Approaches to prevent recurrence
have included chemoembolization before and neoadjuvant therapy after surgery,
neither of which has proven to be beneficial. Liver transplantation has been
successful in treating limited-stage HCC, affecting cure of both the tumor and
underlying cirrhosis. However, only a minority of patients with HCC qualify
for transplantation. Recently, chemoembolization has been shown to prolong survival
in selected patients who do not qualify for transplantation or resection. Other
innovative, relatively noninvasive local ablative therapies have been introduced
and have been shown to be effective in reducing tumor size but not in prolonging
survival. Standard chemotherapy is poorly tolerated in patients who do not qualify
for resection. Both doxorubicin and cisplatin are frequently used, but overall
response rates are low, and neither seems to prolong survival. Prospective,
randomized controlled trials using current therapies are needed to better define
optimal management of this important tumor. Most needed, however, are new therapeutic
agents that are effective against HCC, are noncytotoxic, and are tolerated by
the typical patient with underlying cirrhosis. Newly emerging agents with promise
include 90 Y microspheres, antiangiogenesis agents, inhibitors of growth factors
and their receptors, and K vitamins.
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