Published online Jun 8, 2015. doi: 10.4254/wjh.v7.i10.1412
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
Processing time: 280 Days and 13.3 Hours
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.
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.