Journal
JOURNAL OF HEPATOLOGY
Volume 48, Issue -, Pages S20-S37Publisher
ELSEVIER
DOI: 10.1016/j.jhep.2008.01.022
Keywords
hepatocellular carcinoma; early diagnosis; molecular diagnosis; randomised controlled trials; systematic review; evidence-based medicine; clinical trials; survival; molecular targeted therapies; sorafenib
Categories
Funding
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [R01DK076986] Funding Source: NIH RePORTER
- NIDDK NIH HHS [1R01DK076986-01] Funding Source: Medline
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New advancements have emerged in the field of hepatocellular carcinoma (HCC) in recent years. There has been a switch in the type of presentation of HCC in developed countries, with a clear increase of tumors <2 cm in diameter as a result of the wide implementation of surveillance programs. Non-invasive radiological techniques have been developed and validated for the diagnosis of small and tiny HCCs. Simultaneously, diagnostic criteria based on molecular profiling of early tumors have been proposed. The current clinical classification of HCC divides patients into 5 stages with a specific treatment-oriented schedule. There is no established molecular classification of HCC, although preliminary proposals have already been published. Advancements in the treatment arena have come from well designed trials. Radiofrequency ablation is currently consolidated as providing better local control of the disease compared with percutaneous ethanol injection. New devices are available to improve the anti-tumoral efficacy of conventional chemoembolization. Sorafenib, a multikinase inhibitor, has shown survival benefits in patients at advanced stages of the disease. This advancement represents a breakthrough in the management of this complex disease, and proves that molecular targeted therapies can be effective in this otherwise chemo-resistant tumor. Consequently, sorafenib will become the standard of care in advanced cases, and the control arm for future trials. Now, the research effort faces other areas of unmet need, such as the adjuvant setting of resection/local ablation and combination therapies. (c) 2008 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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