Abstract
Hepatocellular carcinoma (HCC), the second leading cause of cancer deaths worldwide, is difficult to treat and highly lethal. Since HCC is predominantly diagnosed in patients with cirrhosis, treatment planning must consider both the severity of liver disease and tumor burden. To minimize the impact to the patient while treating the tumor, techniques have been developed to target HCC. Anatomical targeting by surgical resection or locoregional therapies is generally reserved for patients with preserved liver function and minimal to moderate tumor burden. Patients with decompensated cirrhosis and small tumors are optimal candidates for liver transplantation, which offers the best chance of long-term survival. Yet, only 20%–30% of patients have disease amenable to anatomical targeting. For the majority of patients with advanced HCC, chemotherapy is used to target the tumor biology. Despite these treatment options, the five-year survival of patients in the United States with HCC is only 16%. In this review we provide a comprehensive overview of current approaches to target HCC. We also discuss emerging diagnostic and prognostic biomarkers, novel therapeutic targets identified by recent genomic profiling studies, and potential applications of immunotherapy in the treatment of HCC.
Highlights
A Surgical Perspective on Targeted Therapy of Hepatocellular CarcinomaDumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA Received: 9 July 2015 / Accepted: 21 September 2015 / Published: 29 September 2015
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer deaths worldwide [1,2]
Representative articles were selected from references found by searching Pubmed for the following key words: Targeting HCC anatomically section: “HCC”, “HCC and surgical resection”, “HCC and anatomical resection”, “liver transplantation and HCC”, “living-donor liver transplantation”, “percutaneous ethanol injection”, “radiofrequency ablation”, “microwave ablation”, “transarterial chemoembolization”, “transarterial radioembolization”, “cryoablation”, “irreversible electroporation”, “laser ablation”, and “high-intensity focused ultrasound;” Targeting HCC tumor biology section: “sorafenib and HCC”, and “kinase inhibitors and HCC”; Future directions section: “serum biomarkers and HCC”, “AFP and HCC”, “DKK1 and HCC”, “microRNAs and HCC”, “metabolomics and HCC”, “gene-expression signatures and HCC”, “immunotherapy and HCC”, “JX-594”, “CTLA-4 and HCC”, and “glypican-3”
Summary
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA Received: 9 July 2015 / Accepted: 21 September 2015 / Published: 29 September 2015
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