Published online Apr 18, 2015. doi: 10.4254/wjh.v7.i5.787
Peer-review started: August 26, 2014
First decision: September 28, 2014
Revised: October 26, 2014
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: April 18, 2015
Primary liver cancer is one of the commonest causes of death. Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancers. For patients with unresectable or metastatic HCC, conventional chemotherapy is of limited or no benefit. Sorafenib is the only systemic treatment to demonstrate a statistically significant but modest overall survival benefit, leading to an era of targeted agents. Many clinical trials of targeted drugs have been carried out with many more in progress. Some drugs like PTK787 showed potential benefits in the treatment of HCC. Despite these promising breakthroughs, patients with HCC still have a dismal prognosis. Recently, both a phase III trial of everolimus and a phase II clinical trial of trebananib failed to demonstrate effective antitumor activity in advanced HCC. Sorafenib still plays a pivotal role in advanced HCC, leading to further explorations to exert its maximum efficacy. Combinations targeted with chemotherapy or transarterial chemoembolization is now being tested and might bring about advances. New targeted agents such as mammalian target of rapamycin inhibitors are under investigation, as well as further exploration of the mechanism of hepatocarcinogenesis.
Core tip: Sorafenib is the first drug and now the only systemic treatment to prolong overall survival benefit in patients with hepatocellular carcinoma. In recent years, many molecular targeted agents have been developed and tested. This review article aims to summarize the efforts of systemic therapeutic options and explore the potential new systemic options for this disease.