Treatment Of Hepatocellular Cancer Research Articles

Experience of using lenvatinib in the treatment of hepatocellular cancer at the Republican Oncology Center of the Republic of North Ossetia-Alania in 2018–2022. Balance of efficiency and accessibility in regional practice

The overall incidence of liver cancer in the Republic of North Ossetia-Alania has remained stable over the past five years. Moreover, the initial diagnostic of HCC occurs at widespread stage, which limits the possibilities of cured therapy. The Republican Oncology Clinic has accumulated experience in using the drug lenvatinib for advanced and metastatic hepatocellular cancer. In the realities of a small regional dispensary, and has to find a balance between efficiency and availability of therapeutic options to provide effective therapy for all patients. The authors conducted a single-center retrospective analysis of the effectiveness and safety of lenvatinib in real clinical practice in patients with hepatocellular cancer at the Republican Oncology Center of the Republic of North Ossetia Alania. The analysis included 18 patients with HCC who received lenvatinib monotherapy. 11(61%) patients had concomitant viral hepatitis B or C, 15 (83%) had distant metastases to the lymph nodes, lungs, adrenal glands or other organs. A feature of this patient population is the long period of time from the prescription of drug therapy for HCC to its actual start – on average 46 days, with a range from 5 to 100 days. We believe that a delay in initiating therapy may affect the results obtained. Median PFS in 1st line of lenvatinib therapy was 10.1 months (2.3 months to 13.1 months). Median PFS2 (defined as the time from 1st line treatment on lenvatinib to progression on first subsequent therapy) was 19.1 months. 6 (33%) patients received lenvatinib in the second line after progression on another drug therapy. The median second-line PFS in this case was 5.9 months (3.8 months‑7.7 months). Lenvatinib had a manageable and predictable tolerability profile. No new safety signals were identified.Conclusion: The use of lenvatinib as monotherapy in adult patients with advanced or unresectable hepatocellular carcinoma has proven to be an effective strategy that balances clinical benefit and availability of the drug.

Optimizing the resveratrol fragments for novel in silico hepatocellular carcinoma de novo drug design

Hepatocellular carcinoma (HCC) incidence varies widely around the world and is impacted by factors such as the prevalence of chronic hepatitis B and C infections, alcohol intake, and access to healthcare. The proteins (BRAF_human, VGFR3_human, EGFR_human and UFO_human) play a vital role in hepatocellular carcinoma prognosis, which involves cell proliferation, cell growth, transmission of extracellular signals to the cell nucleus and consequently regulating many other cellular processes. Fostamatinib has been studied for its possible use in the treatment of hepatocellular cancer because it is a more convenient therapy choice for patients and has minor side effects on the human body. However, resveratrol phytochemical has been investigated for its potential use in the prevention and treatment of a wide range of disorders, including cancer, cardiovascular disease, diabetes, and neurological problems due to its frequently antioxidant, anti-inflammatory, and immune-modulating characteristics, which can aid in the prevention of chronic illnesses. This study developed de novo-based fragment-optimized resveratrol (FOR), enhancing therapeutic potential and lowering toxicity. The docking study was performed with four target proteins, and the findings reveal that the vascular endothelial growth factor receptor 3 protein possessed the highest binding energy values of −7.6 kcal/mol with FOR. Additionally, it completely fulfills the criteria of drug-likeliness rules. Thus, FOR proves to be an efficient drug candidate for future in-vivo studies against hepatocellular carcinoma.

Psychiatric disorders in patients with hepatocellular carcinoma: A large US cohort of commercially insured individuals.

Patients with hepatocellular cancer (HCC) are vulnerable to psychological distress given a new cancer diagnosis superimposed on pre-existing chronic liver disease. We aimed to characterise the psychiatric burden in HCC, risk factors for incident diagnosis and treatment patterns over time. Using IQVIA PharMetrics® Plus for Academics-a nationally representative claims database of the commercially insured US population-we identified psychiatric diagnoses and treatment among patients with newly diagnosed HCC. Multivariable logistic regression modelling identified factors associated with psychiatric diagnosis and treatment. Of 11,609 patients with HCC, 2166 (18.6%) had a psychiatric diagnosis after cancer diagnosis with depression (58.3%) and anxiety (53.0%) being most common. Women (aOR 1.33, 95% CI [1.19-1.49]), pre-existing psychiatric diagnoses (aOR 9.12 [8.08-10.3]) and HCC treatment type (transplant: aOR 2.15 [1.66-2.77]; locoregional therapies: aOR 1.74 [1.52-1.99]; hospice: aOR 2.43 [1.79-3.29]) were significantly associated with psychiatric diagnosis. Female sex, ascites, higher comorbidity and treatment type were associated with incident psychiatric diagnosis. Pharmacotherapy was used in 1392 (64.3%) patients with a psychiatric diagnosis, with antidepressants (46.2%) and anxiolytics (32.8%) being most common. Psychiatric diagnoses increased from 14.8% in 2006-2009 to 21.1% in 2018-2021 (p < 0.001). In almost 20% of patients with pre-existing psychiatric conditions, therapy was discontinued after HCC diagnosis. Nearly 2 of 10 patients with HCC were diagnosed with a psychiatric condition after cancer diagnosis with unique sociodemographic and clinical risk factors identified. This highlights a risk for increased psychological burden in need of early evaluation and treatment among patients with newly diagnosed HCC.

Examining disparities in the receipt of curative treatment for hepatocellular cancer (HCC): A multicenter retrospective study from 2016-2023.

1582 Background: Prior studies suggested disparities in hepatocellular cancer (HCC) treatment and outcomes based on region, race, and socioeconomic status. After the implementation of the Affordable Care Act, including Michigan’s Medicaid Expansion in 2014, there’s increased interest in how these changes affect HCC care. The study examines factors influencing curative treatment receipt and existing disparities, as a step toward intervention strategies. Methods: This is a retrospective study of HCC patients at 6 community-based (4 university-affiliated) hospitals, in Michigan from Jan 2016-Sep 2023. Patients without imaging or histologic confirmation were excluded. Factors associated with receiving curative treatment were determined using both univariate and multivariable logistic regressions. Analysis was done using SPSS 28, with a p-value&lt;0.05 indicating statistical significance. Results: Of 680 HCC patients screened, 347 were analyzed. The mean age was 70 years, and 71% were male. 78.3% were White and 16.9% Black. 53.9% had private insurance and 35% had government insurance. Primary HCC etiologies were alcohol and hepatitis C virus (HCV) infection; 74.4% had cirrhosis. Barcelona Clinic Liver Cancer (BCLC) stages varied: A (10.6%), B (28.2%), C (36.4%), and D (24.8%). 59.4% underwent curative treatment (4.6% resection, 30.3% liver-directed, 13.3% systemic, 10.1% combination), while 38.3% had best supportive care. Univariate analysis identified many factors associated with receipt of curative treatment, including race (White&gt;Black), insurance (private&gt;government), earlier BCLC stages, ECOG 0/1/2, Child-Pugh A, lower MELD-Na score (mean=12), &lt;400 alpha-fetoprotein levels, and better liver function (Bilirubin, INR, albumin). Tumor characteristics, such as smaller size, absence of metastasis, and absence of portal vein thrombosis, were also associated with receipt of curative treatment. Overall, the one-year survival rate was 64% for those who had curative treatment and 35% for best supportive care. All with p-value&lt;0.05. Multivariable analysis showed Black patients (OR: 0.21, CI: 0.051-0.881) with larger tumors (OR:0.89, CI: 0.783-1.00) and lower albumin levels (OR:3.81, CI: 1.649-8.805) at presentation were less likely to receive curative treatment than White. Black patients were also diagnosed at a younger age (66.7 vs. 71.0 years, p=0.01), more advanced BCLC stages C/D (74% vs. 57%, p=0.04) on presentation, and HCV coinfection (58% vs. 32%, p&lt;0.001) than White. Median survival for Black and White were 757 days and 823 days, respectively (p=0.89). Conclusions: Black patients with larger tumors and low albumin are less likely to receive curative treatment than White. HCV coinfection in the Black population suggests a focus area for early intervention. Further investigation of HCC disparities across various settings is warranted.

Sorafenib tosylate-loaded nanosuspension: preparation, optimization, and in vitro cytotoxicity study against human HepG2 carcinoma cells

This study aimed to optimize nanosuspension of sorafenib tosylate (an anticancer hydrophobic drug molecule) using a central composite design. Nanosuspension was prepared using a nanoprecipitation-ultrasonication approach. FTIR and DSC analyses demonstrated that the drug and excipients were physicochemically compatible. X-ray powder diffraction analysis confirmed amorphous form of the payload in the formulation. The optimized formulation (batch NSS6) had a zeta potential of −18.1 mV, a polydispersity of 0.302, and a particle size of 97.11 nm. SEM analysis confirmed formation of rod-shaped particles. After 24 h, about 64.45% and 86.37% of the sorafenib tosylate was released in pH 6.8 and pH 1.2, respectively. The MTT assay was performed on HepG2 cell lines. IC50 value of the optimized batch was 39.4 µg/mL. The study concluded that sorafenib tosylate nanosuspension could be a promising approach in the treatment of hepatocellular cancer.

Crosstalk between autophagy inhibitor and salidroside-induced apoptosis: A novel strategy for autophagy-based treatment of hepatocellular cancer

Autophagy regulates many cell function related to cancer, including cell proliferation, invasion and apoptosis. Therefore, we investigated the potential value of crosstalk between autophagy and apoptosis. The present study demonstrated that seven autophagy related genes were screened from the biological network of salidroside (Sal) acting on liver cancer. The GO analysis showed that these genes were mainly involved in apoptosis and autophagy. The KEGG analysis showed that these genes regulated the process of liver cancer through Th17 cell differentiation, PI3K-Akt signaling pathway and other pathways. Moreover, seven genes were positively correlated with tumor purity, number of B cells, number of CD4+ T cells, number of CD8+ T cells, number of macrophages, number of dendritic cells and number of neutrophils. The overall survival time of liver cancer patients in the high expression group of BIRC5, HSP90AB1 and MTOR was lower than that in the low expression group (P < 0.05), while the overall survival time of the liver cancer patients in the high expression group of DLC1 and FOXO1 was higher than that in the low expression group (P < 0.05). In the pan-cancer analysis, we also found that BIRC5, HSP90AB1, MTOR, and ITGA6 were highly expressed in various cancers, while DLC1, FOXO1, and FOS were low expressed in various cancers. In the molecule docking analysis, we found that FOS, HSP90AB1, and MTOR had the best binding ability. Notably, in the vitro validation experiments, Sal was confirmed to induce autophagy and apoptosis, inhibite invasion and metastasis of liver cancer cells through the PI3K/Akt/mTOR signaling pathway. Meanwhile, inhibition of autophagy by chloroquine diphosphate (CQ) promoted Sal-induced mitochondrial apoptosis via corresponding cell and animal experiments. We speculated that Sal-induced autophagy might be a protective mechanism, inhibition of autophagy could further promote the progression of liver cancer. It may provide important insight into the molecular mechanism of crosstalk between autophagy and apoptosis, and provide a new theoretical basis of Sal combined with autophagy inhibitors as a adjuvant chemotherapeutic strategy for human liver cancer.

Resection interventions in the treatment of hepatocellular cancer in a specialized surgery center

Background. The relevance of the treatment of hepatocellular cancer (HCC) is determined by a significant increase in the incidence rate and its high prevalence among primary malignant hepatic tumors.The aim of the study. To summarize the experience of providing specialized medical care to patients with hepatocellular cancer.Methods. We studied the direct results of treatment of patients with primary hepatic cancer treated at the Kuzbass Regional Hepatological Center for the period from January 2015 to August 2022. The materials for the study were medical records of patients with an established diagnosis of primary hepatic cancer, surgical records, results of pathohistologic examination. The exclusion criterion was diagnosed cholangiocellular carcinoma.Results. During the period from 2015 to 2022, 59 patients with primary hepatic cancer were treated at the Kuzbass Regional Hepatological Center. Among them, hepatocellular cancer was diagnosed in 48 cases, cholangiocellular cancer – in 11 cases; radical surgery was performed in 12 patients with hepatocellular cancer; fatal outcome was noted in 1 (2.1 %) patient, complications in the postoperative period developed in 5 (41.7 %) cases and were ranked as I-3, IIIb-1 and IVb-1 according to Clavien – Dindo classification.Conclusion. The degree of risk of severe post-resection hepatic failure should be considered one of the main criteria in choosing a strategy for radical surgical treatment. New surgical approaches (laparoscopic vascular isolation of the portal blood flow, using temporary hemostasis in laparoscopic hepatic resections and the device for its implementation) in resection surgery of primary hepatic cancer can improve the immediate results of treatment.

Anti-Glycolytic Drugs in the Treatment of Hepatocellular Carcinoma: Systemic and Locoregional Options.

Hepatocellular cancer (HCC) is the most common primary liver cancer and the third leading cause of cancer-related death. Locoregional therapies, including transarterial embolization (TAE: bland embolization), chemoembolization (TACE), and radioembolization, have demonstrated survival benefits when treating patients with unresectable HCC. TAE and TACE occlude the tumor's arterial supply, causing hypoxia and nutritional deprivation and ultimately resulting in tumor necrosis. Embolization blocks the aerobic metabolic pathway. However, tumors, including HCC, use the "Warburg effect" and survive hypoxia from embolization. An adaptation to hypoxia through the Warburg effect, which was first described in 1956, is when the cancer cells switch to glycolysis even in the presence of oxygen. Hence, this is also known as aerobic glycolysis. In this article, the adaptation mechanisms of HCC, including glycolysis, are discussed, and anti-glycolytic treatments, including systemic and locoregional options that have been previously reported or have the potential to be utilized in the treatment of HCC, are reviewed.

Does Vascular Collapse Occur After Treatment of Hepatocellular Cancer With Stereotactic Body Radiation Therapy?

There is debate about why stereotactic body radiation therapy (SBRT) produces superior control of hepatocellular cancer (HCC) compared to fractionated treatment. Both preclinical and clinical evidence has been presented to support a "classic" biological explanation: the greater BED of SBRT produces more DNA damage and tumor cell kill. More recently, preclinical evidence has supported the concept of a "new biology", particularly radiation-induced vascular collapse, which increases hypoxia and free radical activation. This is hypothesized to cause much greater tumor cell death than was produced by the initial radiation-induced DNA damage to the tumor. We decided to investigate if vascular collapse occurs after standard SBRT for patients with HCC. Eight patients with 10 lesions underwent dynamic contrast enhanced MRI at the time of simulation and either 48 or 96 hours after the first fraction. Only three of 10 tumors showed a decrease in blood flow. These findings suggest that vascular collapse does not typically occur after SBRT for HCC.

Impact of COVID-19 on 1-Year Survival Outcomes in Hepatocellular Carcinoma: A Multicenter Cohort Study.

The COVID-19 pandemic has caused severe disruption of healthcare services worldwide and interrupted patients' access to essential services. During the first lockdown, many healthcare services were shut to all but emergencies. In this study, we aimed to determine the immediate and long-term indirect impact of COVID-19 health services utilisation on hepatocellular cancer (HCC) outcomes. A prospective cohort study was conducted from 1 March 2020 until 30 June 2020, correlating to the first wave of the COVID-19 pandemic. Patients were enrolled from tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDM) were identified. Any delay to treatment (DTT) and the effect on survival at one year were reported. The median time to receipt of therapy following MDM discussion was 49 days. Patients with Barcelona Clinic Liver Cancer (BCLC) stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed, but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate into reduced survival in patients. Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay in therapy in those receiving curative therapy.

Circular RNA circBNC2 facilitates glycolysis and stemness of hepatocellular carcinoma through the miR-217/high mobility group AT-hook 2 (HMGA2) axis

Hepatocellular cancer (HCC) accounts for approximately 90% of primary liver carcinoma and is a significant health threat worldwide. Circular RNA basonuclin 2 (circBNC2) is implicated with the progression of several cancers. However, its roles in carcinogenesis and glycolysis are still unclear in HCC. In this study, the levels of circBNC2 and high mobility group AT-hook 2 (HMGA2) were highly expressed, while these of miR-217 were poorly expressed in HCC tissues and cells. Upregulation of circBNC2 was related to poor prognosis and tumor node metastasis (TNM) stage. Knockdown of circBNC2 inhibited the HCC progression. Moreover, knockdown of circBNC2 suppressed the levels of Ras, ERK1/2, PCNA, HK2, and OCT4. Notably, circBNC2 functioned as a molecular sponge of microRNA 217 (miR-217) to upregulate the HMGA2 expression. The inhibitory effects of the circBNC2 silence on the growth and stemness of HCC cells, and levels of PCNA, HK2 and OCT4 were aggravated by the miR-217 overexpression, but neutralized by the HMGA2 overexpression. Besides, silencing of circBNC2 blocked the tumor growth through upregulating the expression of miR-217 and downregulating the levels of HMGA2, PCNA2, HK2 and OCT4 in vivo. Thus, the current data confirmed that circBNC2 sponged miR-217 to upregulate the HMGA2 level, thereby contributing to the HCC glycolysis and progression. These findings might present novel insight into the pathogenesis and treatment of HCC.

Efficacy of low dose sorafenib and capecitabine in the management of hepatocellular cancer.

e16117 Background: Hepatocellular cancer (HCC) is one of the commonest cancers in Pakistan due to endemic hepatitis B and C diseases. Its incidence is continuously rising due to lack of public awareness and lack of routine screening of the affected population. Most of the patients present in advanced stage of the disease excluding option for curative surgical options. These patients are mostly not fit enough to tolerate systemic therapies in full doses. So, we have to adapt ourselves to lower dosage so that it can be tolerated without many untoward side effects. Methods: This study was aimed to assess the efficacy of low dose sorafenib (400 mg daily in two divided doses) and capecitabine (1000 mg daily in two divided doses) in advanced hepatocellular carcinoma. Patients were prescribed this treatment for six months and then response was assessed using computed tomography or ultrasound and alpha fetoprotein (AFP) levels. Progression-free survival (PFS) and overall survival (OS) were also assessed. Results: Total of one-hundred fifty-five patients were enrolled. One hundred thirteen patients completed the treatment for six months and were evaluated for response. A total of 28 (25%) of patients progressed during treatment and were shifted to other treatment options. Nine patients (8%) had complete response, thirty-four (30%) had partial response, forty-two (37%) had stable disease and twenty-eight (25%) had progressive disease. Seventy-four patients (65%) showed significant reduction in AFP levels. A total of 85/113 (75%) patients were available for assessment of PFS and OS. Two-year PFS and OS were 32% and 43% respectively. Mean and median PFS (year) were 1.82 ±0.19 (95% confidence interval 1.48 to 2.17) and 1.27±0.16 (95% confidence interval 0.94 to 1.57) respectively. Mean and median OS (year) were 2.73 ±0.24 (95% confidence interval 2.39 to 3.16) and 2.27±0.13 (confidence interval 2.02 to 2.54) respectively. Twenty-six patients had one or more episode of grade 2 diarrhea, eleven patients developed encephalopathy, thirteen patients developed hand foot syndrome and nineteen patients showed grade 2 thrombocytopenia. Conclusions: Low dose sorafenib and capecitabine is effective in the treatment of advanced HCC with excellent tolerability and minimal toxicity.

Abstract 4116: Modulating gut microbiota to improve intrahepatic immunity against hepatocellular cancer

Abstract Gut microbiota plays a pivotal role in the pathogenesis of hepatocellular cancer (HCC), significantly affecting the HCC treatment. It has been reported that the HCC patients’ response to the immunotherapy of PD-1/PD-L1 blockade was associated with their gut microbiota profiles. However, the impact of gut microbiota on anti-HCC immunity and its underlying mechanism are poorly understood. Treating HCC-bearing mice with a specific and non-hepatotoxic antibiotic cocktail caused the increased relative abundance of specific commensal bacteria such as Bacteroides, resulting in suppression of HCC growth and development which was involved in the activation of intrahepatic antitumor immune responses. Gut microbiota recolonization of Bacteroides thetaiotaomicron (B. th) in gut-sterilized HCC-bearing mice significantly improved the therapeutic efficacy of anti-PD-1 antibody (αPD-1 Ab) against HCC. Fecal microbiota transplantation (FMT) from HCC patients who received and responded to αPD-1 Ab treatment improved the efficacy of αPD-1 Ab treatment against HCC in mice model. Mechanistic studies demonstrated that the modulation of Krüppel-like factor 2 (KLF2)/Toll-like receptor 9 (TLR9) signaling and the accumulation of CpG-enriched genomic DNAs of B. th in livers/tumors activated the tumor antigen-specific CD8+ T cells through the dendritic cell in a TLR9-dependent manner. In conclusion, gut microbiota as a causative factor can be targeted to improve anti-HCC immunotherapy. Citation Format: Xiaogiang Qi, Ming Yang, Lixin Ma, Jonathan Mitchem, Jussuf Kaifi, Shiyou Chen, Aaron Ericsson, Eric Kimchi, Kevin Staveley-O’Carroll, Guangfu Li. Modulating gut microbiota to improve intrahepatic immunity against hepatocellular cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4116.

Stereotactic body radiation therapy (SBRT) in patients with hepatocellular cancer-a narrative review and expert opinion.

Stereotactic body radiation therapy (SBRT) is a highly conformal technique of external beam radiotherapy precisely delivering high total (ablative) doses in a small number of fractions to clearly defined target volumes. Its development enabled efficient and safe radiation treatments in patients with localized hepatocellular cancer (HCC) unsuitable for other local treatment options. Moreover, it can be easily combined with several other therapy approaches. Thus, the aim of this narrative review is to outline the current role of SBRT in the multifocal treatment of HCC patients. We searched PubMed for articles dealing with SBRT alone, in combination with other local or systemic treatments or in comparison to other local treatments in patients with HCC. This included original articles, reviews and conceptional articles dealing with the technique of SBRT. All articles were analysed for suitability by two independent reviewers. This review summarizes the currently available evidence for SBRT as a definitive treatment for HCC as well as its role within combination approaches including bridging to transplantation. SBRT is an effective and safe definitive treatment option in patients with localized HCC unsuitable for surgery and/or other local therapies based on retrospective and prospective series. Its combination with other local treatments yields superior results compared to single modality treatment based on non-randomized data. A growing number of prospective trials confirmed at least similar if not superior rates of local control with low toxicities compared to well established other local treatments even in non-selected patients. SBRT is a promising tool in the treatment of HCC. It can be used either as definitive treatment, within combination approaches or as a bridging tool. Several phase III trials comparing SBRT with other local options are ongoing, which will further clarify its encouraging role.

Synthesis and characterization of silica nanoparticles from rice ashes coated with chitosan/cancer cell membrane for hepatocellular cancer treatment

Dual pH-sensitive smart nanocarriers based on silica nanoparticles (SNPs) extracted from rice husk ashes (RHAs) to effectively inhibit liver cancer cell proliferation were investigated. The SNPs were coated with chitosan (CH) and loaded with doxorubicin (DOX), then functionalized with cell membrane (CM) for homologous targeting ability. The FTIR spectra showed an absorption wave number at 1083 cm−1 which confirmed the existence of the SiOSi group, ratifying that the nanocarriers belong to silica species. The Korsmeyer-Peppas kinetic model reported R2 values of 0.996 and 0.931 for pH = 5.4 and pH = 7.4, respectively, demonstrating pH-responsive behavior of the nanocarriers. The cytotoxicity test confirmed that the HepG2 cell line treated with different SNP–CH–CM concentrations had no detectable significant cell toxicity, however, SNP–CH–DOX–CM induced greater cell death. In vivo tests revealed that SNP–CH–DOX–CM suppressed liver cancer growth in nude mice, demonstrating high pharmaceutical capability. Histological examination of vital organs showed that the targeted drug delivery system (DDS) had minor in vivo toxicity. In the light of its high treatment efficacy and minimal side effects, the investigated DDS is promising for the therapy of liver cancer.

Cabozantinib in hepatocellular cancer: from preclinical experiments to observational studies

Based on the results of registration studies, the drug cabozantinib, the mechanism of action of which is determined by the inhibition of tyrosine kinases on a relatively wide range of cellular receptors, is registered in the treatment of hepatocellular cancer, kidney cancer and thyroid cancer. This literature review collects data on the mechanism of action, the results of preclinical experiments and phases I–III studies. Emphasis is placed on the tolerability and efficacy of the drug in the population of hepatocellular cancer patients.

Characteristics and treatment strategies for hepatocellular carcinoma caused by nonalcoholic fatty liver disease

In recent years, nonalcoholic fatty liver disease (NAFLD) incidence has rapidly increased, and it is gradually becoming a major contributor to liver cirrhosis and hepatocellular cancer (HCC). The degree of liver fibrosis, diabetes mellitus (DM), obesity, age, and gender are the main risk factors for nonalcoholic steatohepatitis (NASH) progression to HCC. Patients with NASH-related HCC are predominantly male, and almost all of them have at least one metabolic disorder (obesity, DM, dyslipidemia, hypertension, etc.). Most HCCs manifest as solitary tumor nodules and a significant number of NASH-related HCCs are non- cirrhotic. Case fatality rates are similar across patients with cirrhotic and noncirrhotic HCC, despite the fact that patients with noncirrhotic HCC tend to be older, have a single macronodular tumor, and have lower incidence of type 2 diabetes and liver transplantation. Controlling the risk factors for NASH might thereby minimize the likelihood of developing HCC. The BCLC staging system should be used as a guide to treat patients with NASH-related HCC. The long-term outcomes of NAFLD-related HCC treatment are similar to those for other HCCs of different etiologies. However, patients combined with metabolic syndrome are at high perioperative risk, so apporpriate preoperative preparation, especially cardiac examination, is essential to avoid this risk.

Attenuation of N-Nitrosodiethylamine -Induced Hepatocellular Carcinoma by Piceatannol and/or Cisplatin: The Interplay between Nuclear Factor (Erythroid Derived 2)-like 2 and Redox Status.

The natural compound's alternative and complementary uses have increased hopes for hepatocellular cancer treatment (HCC). The goal of this study was to see if Piceatannol (PIC) in combination with cisplatin has a synergistic effect on N, N-nitrosodiethylamine (DEN)-induced HCC in rats. Tissue antioxidant enzymes, malondialdehyde (MDA), and nuclear factor erythroid 2 related factors 2 (Nrf2) and tumor necrosis factor α (TNF-α) gene expression were all measured. Nuclear Factor Kabba B (NF-κB) was also tested, as well as hepatic caspase 3 and NAD (P) H quinone oxidoreductase 1 (NQO1). Liver specimens were subjected to histopathological analysis. When compared to the HCC group, piceatannol and/or cisplatin caused a significant improvement in liver function tests, as well as a significant modulation in Nrf2 gene expression and antioxidant enzyme activities, as well as a significant decrease in tissue MDA, TNF-α, NF-κB levels, NQO1 activity, and prompt and caspase-3 activities. When the PIC and/or cisplatin combination was compared to each of these compounds alone, the results were substantial. PIC in combination with cisplatin has been shown to have a synergistic anticancer impact through modulating Nrf2 and redox state. In addition, adding PIC to an HCC therapy plan that includes chemotherapeutic medicines may boost the efficacy of cisplatin while reducing its negative effects.

Fabrication of novel ruthenium loaded silk fibroin nanomaterials for fingolimod release improved antitumor efficacy in hepatocellular carcinoma

Cancer targeted nanomaterials-based drug delivery systems have been described as promising. In this work, we employed silk fibroin (SF), ruthenium nanomaterials (RuNMs), heptapeptide (T7), and fingolimod (FTY720) to construct a pH-responsive smart nanomaterials drug delivery system. They were spherical with a mean size of around 120 nm, which may have contributed to the improved penetration and retention of the NMs in tumour areas. T7-FTY720@SF-RuNMs had an encapsulation efficiency (EE) of 72.51 ± 4.02%. When the pH of an environment is acidic, the release of FTY720 from nanocarriers is enhanced. T7-FTY720@SF-RuNMs demonstrated increased cellular uptake selective and anticancer efficacy for hepatocellular cancer in both in vitro and in vivo experiments. Additionally, the in vivo biodistribution investigation showed that T7-FTY720@SF-RuNMs could efficiently aggregate in the tumour location, improving their in vivo potential to kill cancer cells. T7-FTY720@SF-RuNMs demonstrated little toxicity to tumour-bearing animals in investigations of histology and immunohistochemistry, showing that the fabricated NMs are biocompatible in vivo. For the treatment of hepatocellular cancer, the T7-FTY720@SF-RuNMs delivery method offers significant promise.

Effect of Comprehensive Nursing Approach in Perioperative Stage of Patients with Hepatocellular Carcinoma Interventional Therapy.

Objective To examine the efficacy of a complete nursing strategy during the perioperative phase for patients undergoing interventional treatment for hepatocellular cancer. Methods Sixty patients who were diagnosed with liver cancer and underwent interventional therapy in our hospital between February 2019 and December 2021 were recruited in this trial. All study subjects were numbered according to the time when the patients first came to our hospital, and were equally divided into a comprehensive group and a conventional group based on the odd and even number of the last number, with 30 cases in each group. Those in the conventional group received conventional nursing care, whereas patients in the comprehensive group received comprehensive nursing care. Before and after the nursing intervention, the quality of life, pain, and patient satisfaction in both groups were compared. Results The quality of survival scores, including physical, emotional, role, social, and cognitive function scores of patients in the comprehensive group, were significantly higher than those in the conventional group (P < 0.05); there was no statistically significant difference in numeric rating scales (NRS) scores between the two groups compared before treatment (P > 0.05). After treatment, the NRS scores of patients in the study group were significantly lower than those of patients in the control group (P < 0.05); before the intervention, the difference between the emotional state scores of patients in the two groups was not significant and not statistically significant (P > 0.05), while the emotional state of patients in both groups improved after the intervention, and the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) scores of patients in the comprehensive group were lower than those in the conventional group (P < 0.05); the total incidence of adverse reactions in the comprehensive group (10.00%) was significantly lower than that in the conventional group (46.67%) (P < 0.05); and the total satisfaction of patients in the comprehensive group (93.33%) was significantly higher than that of patients in the conventional group (73.33%) (P < 0.05). Conclusion The intervention of a comprehensive nursing approach in the perioperative period for patients with liver cancer is remarkable as it can relieve patients' psychological burden and pain, ensure a smooth operation, improve patients' postoperative quality of life, and also help to reduce the risk of postoperative adverse reactions, effectively enhancing patients' satisfaction, and thus deserves to be promoted in clinical practice.