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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2018; 10(9): 571-584
Published online Sep 27, 2018. doi: 10.4254/wjh.v10.i9.571
Treatment strategies for advanced hepatocellular carcinoma: Sorafenib vs hepatic arterial infusion chemotherapy
Issei Saeki, Takahiro Yamasaki, Masaki Maeda, Takuro Hisanaga, Takuya Iwamoto, Koichi Fujisawa, Toshihiko Matsumoto, Isao Hidaka, Yoshio Marumoto, Tsuyoshi Ishikawa, Naoki Yamamoto, Yutaka Suehiro, Taro Takami, Isao Sakaida
Issei Saeki, Masaki Maeda, Takuya Iwamoto, Isao Hidaka, Tsuyoshi Ishikawa, Taro Takami, Isao Sakaida, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
Takahiro Yamasaki, Toshihiko Matsumoto, Yutaka Suehiro, Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
Takuro Hisanaga, Department of Medical Education, Yamaguchi University Graduate School of Medicine, Yamaguchi 755-8505, Japan
Koichi Fujisawa, Center of Research and Education for Regenerative Medicine, Yamaguchi University Graduate School of Medicine, Yamaguchi, 755-8505, Japan
Yoshio Marumoto, Center for Clinical Research, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
Naoki Yamamoto, Yamaguchi University Health Administration Center, Yamaguchi 753-8511, Japan
Author contributions: Saeki I, Yamasaki T, Maeda M, Hisanaga T, Iwamoto T, Fujisawa K, Matsumoto T, Hidaka I, Marumoto Y, Ishikawa T and Yamamoto N analyzed the literature; Saeki I and Yamasaki T were involved in writing the manuscript; Takami T and Suehiro Y were involved in editing the manuscript; Yamasaki T and Sakaida I were involved in critical editing of the manuscript.
Supported by the Japan Society for the Promotion of Science, KIBAN-B, No. 16H05287.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takahiro Yamasaki, MD, PhD, Professor, Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube 755-8505, Japan. t.yama@yamaguchi-u.ac.jp
Telephone: +81-836-222336 Fax: +81-836-222338
Received: March 27, 2018
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
Processing time: 184 Days and 2.1 Hours
Abstract

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.

Keywords: Treatment strategy; Hepatic arterial infusion chemotherapy; Sorafenib; Hepatocellular carcinoma

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.