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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 8, 2015; 7(10): 1412-1420
Published online Jun 8, 2015. doi: 10.4254/wjh.v7.i10.1412
Current systemic treatment of hepatocellular carcinoma: A review of the literature
Kai-Wen Chen, Tzu-Ming Ou, Chin-Wen Hsu, Chi-Ting Horng, Ching-Chang Lee, Yuh-Yuan Tsai, Chi-Chang Tsai, Yi-Sheng Liou, Chen-Chieh Yang, Chao-Wen Hsueh, Wu-Hsien Kuo
Kai-Wen Chen, Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
Kai-Wen Chen, Tzu-Ming Ou, Wu-Hsien Kuo, Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11464, Taiwan
Tzu-Ming Ou, Ching-Chang Lee, Yuh-Yuan Tsai, Chi-Chang Tsai, Chao-Wen Hsueh, Wu-Hsien Kuo, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
Chin-Wen Hsu, Chi-Ting Horng, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
Yi-Sheng Liou, Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Yi-Sheng Liou, Department of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
Chen-Chieh Yang, Division of Gastroenterology, Department of Internal Medicine, Mennonite Christian Hospital, Hualien 97059, Taiwan
Author contributions: Kuo WH designed the research; Chen KW, Ou TM and Kuo WH performed the research; Hsu CW, Horng CT, Lee CC, Tsai YY, Tsai CC, Liou YS, Yang CC, Hsueh CW and Kuo WH analyzed the data; Chen KW, Ou TM and Kuo WH wrote the paper.
Conflict-of-interest: The authors declare that they have no competing interests.
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: Wu-Hsien Kuo, MD, PhD, Professor, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd., Lingya District, Kaohsiung 80284, Taiwan. wuhsienku@gmail.com
Telephone: +886-7-7495986 Fax: +886-7-7491056
Received: August 26, 2014
Peer-review started: August 27, 2014
First decision: September 28, 2014
Revised: November 29, 2014
Accepted: March 30, 2015
Article in press: April 2, 2015
Published online: June 8, 2015
Abstract

Hepatocellular carcinoma (HCC) is the fifth most common form of human cancer worldwide and the third most common cause of cancer-related deaths. The strategies of various treatments for HCC depend on the stage of tumor, the status of patient’s performance and the reserved hepatic function. The Barcelona Clinic Liver Cancer (BCLC) staging system is currently used most for patients with HCC. For example, for patients with BCLC stage 0 (very early stage) and stage A (early stage) HCC, the curable treatment modalities, including resection, transplantation and radiofrequency ablation, are taken into consideration. If the patients are in BCLC stage B (intermediate stage) and stage C (advanced stage) HCC, they may need the palliative transarterial chemoembolization and even the target medication of sorafenib. In addition, symptomatic treatment is always recommended for patients with BCLC stage D (end stage) HCC. In this review, we will attempt to summarize the historical perspective and the current developments of systemic therapies in BCLC stage B and C in HCC.

Keywords: Hepatocellular carcinoma, Transarterial chemoembolization, Sorafenib, Systemic treatment, Molecular target therapy

Core tip: Sorafenib is a multi-targeted tyrosine kinase inhibitor that was the first systemic therapy in the world to improve the survival rate of patients with advanced hepatocellular carcinoma (HCC) in a phase III trial. However, the overall outcomes are sometimes unsatisfactory and there is a need for second line therapies in patients with advanced HCC who still progress after the use of sorafenib. Novel systemic approaches are needed in advanced HCC.