Published online Sep 27, 2018. doi: 10.4254/wjh.v10.i9.571
Peer-review started: March 27, 2018
First decision: April 18, 2018
Revised: July 30, 2018
Accepted: August 6, 2018
Article in press: August 7, 2018
Published online: September 27, 2018
Sorafenib is used worldwide as a first-line standard systemic agent for advanced hepatocellular carcinoma (HCC) on the basis of the results of two large-scale Phase III trials. Conversely, hepatic arterial infusion chemotherapy (HAIC) is one of the most recommended treatments in Japan. Although there have been no randomized controlled trials comparing sorafenib with HAIC, several retrospective analyses have shown no significant differences in survival between the two therapies. Outcomes are favorable for HCC patients exhibiting macroscopic vascular invasion when treated with HAIC rather than sorafenib, whereas in HCC patients exhibiting extrahepatic spread or resistance to transcatheter arterial chemoembolization, good outcomes are achieved by treatment with sorafenib rather than HAIC. Additionally, sorafenib is generally used to treat patients with Child-Pugh A, while HAIC is indicated for those with either Child-Pugh A or B. Based on these findings, we reviewed treatment strategies for advanced HCC. We propose that sorafenib might be used as a first-line treatment for advanced HCC patients without macroscopic vascular invasion or Child-Pugh A, while HAIC is recommended for those with macroscopic vascular invasion or Child-Pugh A or B. Additional research is required to determine the best second-line treatment for HAIC non-responders with Child-Pugh B through future clinical trials.
Core tip: In Japan, sorafenib and hepatic arterial infusion chemotherapy (HAIC) are described as treatment options for hepatocellular carcinoma (HCC). Although no randomized controlled trials have compared these treatments, retrospective analyses have shown similar survival between them. Sorafenib is generally used for Child-Pugh A, while HAIC is indicated for Child-Pugh A or B. Compared to sorafenib, HAIC shows better responses in cases exhibiting macroscopic vascular invasion. After reviewing treatment strategies for advanced HCC, we recommended sorafenib as first-line treatment for cases without macroscopic vascular invasion or Child-Pugh A, and HAIC for those with macroscopic vascular invasion or Child-Pugh A or B.