Abstract
Hepatocellular carcinoma, one of the most dreaded complications of cirrhosis, is a frequent cancer with high mortality. Early primary liver cancer can be treated by surgery or ablation techniques, but advanced hepatocellular carcinoma remains a challenge for clinicians. Most of these patients have underlying cirrhosis, which complicates or even precludes treatment. Therefore, efficacious treatments without major side effects are welcomed. Initial results of treatment of advanced hepatocellular carcinoma with somatostatin analogues were promising, but subsequent trials have resulted in conflicting outcomes. This might be explained by different patient populations, differences in dosage and type of treatment and differences in somatostatin receptor expression in the tumor or surrounding tissue. It has been shown that the expression of somatostatin receptors in the tumor might be of importance to select patients who could benefit from treatment with somatostatin analogues. Moreover, somatostatin receptor expression in hepatocellular carcinoma has been shown to correlate with recurrence, prognosis, and survival. In this review, we will summarize the available data on treatment of primary liver cancer with somatostatin analogues and analyze the current knowledge of somatostatin receptor expression in hepatocellular carcinoma and its possible clinical impact.
Highlights
According to 2018 statistics of the World Health Organization, liver cancer is the sixth most frequent cancer and the fourth most frequent cause of cancer related death worldwide
It has been shown that the expression of somatostatin receptors in the tumor might be of importance to select patients who could benefit from treatment with somatostatin analogues
Somatostatin analogues have been used with inconsistent success to treat advanced hepatocellular carcinoma (HCC)
Summary
According to 2018 statistics of the World Health Organization, liver cancer is the sixth most frequent cancer and the fourth most frequent cause of cancer related death worldwide. Patients with very early stage BCLC 0 (single tumor < 2 cm, no vascular invasion, good health status Eastern Cooperative Oncology Group (ECOG) 0 and well-preserved liver function) have a good prognosis and can be treated by surgery or ablation techniques. Intermediate BCLC stage B (Multinodular tumor that is unresectable, preserved liver function, but still good health status ECOG 0) can be treated by chemoembolization, which augments median survival from 16 to approximately 40 months. Patients with advanced HCC, BCLC stage C, (symptomatic tumors, ECOG 1-2, macrovascular invasion and/or extrahepatic spread) have a poor prognosis, with expected median survival time of 6 to 8 months. Patients with end-stage disease are characterized by very poor performance status (ECOG 3-4) and/or end stage liver function At this moment, best supportive care is the only option for these patients who have a median survival of 3 to 4 months [1,5]. The reason why results were inconsistent is not completely clear, but in all probability treatment as well as patient populations and tumor characteristics were very diverse in the different trials, which can explain inconsistent outcome
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