Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 8, 2015; 7(4): 673-687
Published online Apr 8, 2015. doi: 10.4254/wjh.v7.i4.673
Recent advances in multidisciplinary management of hepatocellular carcinoma
Asmaa I Gomaa, Imam Waked
Asmaa I Gomaa, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
Author contributions: Gomaa AI and Waked I reviewed the literature and wrote the manuscript.
Conflict-of-interest: None related to this work; Waked I is speaker for Roche HL, MSD, BMS, and Gilead; advisory board for Janssen, Roche HL, and MSD; investigator for Roche HL, BMS, Bayer, Janssen, AbbVie, and Gilead.
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:
Correspondence to: Asmaa I Gomaa, MD, Hepatology Department, National Liver Institute, Menoufiya University, Gamal Abd El-Nasir, Shebeen El-Kom 35111, Egypt.
Telephone: +20-100-6157160 Fax: +20-48-2234586
Received: August 28, 2014
Peer-review started: August 28, 2014
First decision: November 27, 2014
Revised: December 17, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: April 8, 2015

The incidence of hepatocellular carcinoma (HCC) is increasing, and it is currently the second leading cause of cancer-related death worldwide. Potentially curative treatment options for HCC include resection, transplantation, and percutaneous ablation, whereas palliative treatments include trans-arterial chemoembolization (TACE), radioembolization, and systemic treatments. Due to the diversity of available treatment options and patients’ presentations, a multidisciplinary team should decide clinical management of HCC, according to tumor characteristics and stage of liver disease. Potentially curative treatments are suitable for very-early- and early-stage HCC. However, the vast majority of HCC patients are diagnosed in later stages, where the tumor characteristics or progress of liver disease prevent curative interventions. For patients with intermediate-stage HCC, TACE and radioembolization improve survival and are being evaluated in addition to potentially curative therapies or with systemic targeted therapy. There is currently no effective systemic chemotherapy, immunologic, or hormonal therapy for HCC, and sorafenib is the only approved molecular-targeted treatment for advanced HCC. Other targeted agents are under investigation; trials comparing new agents in combination with sorafenib are ongoing. Combinations of systemic targeted therapies with local treatments are being evaluated for further improvements in HCC patient outcomes. This article provides an updated and comprehensive overview of the current standards and trends in the treatment of HCC.

Keywords: Hepatocellular carcinoma, Molecular targeted agents, Radiofrequency ablation, Sorafenib, Trans-arterial chemoembolization

Core tip: This article reviews the available treatment options for hepatocellular carcinoma. The recent clinical trials of molecular-targeted therapies, as single agents or in combination with other treatments, are reviewed, and some future study directions are addressed. The importance of a multidisciplinary approach to management is highlighted.