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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 18, 2015; 7(8): 1041-1053
Published online May 18, 2015. doi: 10.4254/wjh.v7.i8.1041
Advanced hepatocellular carcinoma and sorafenib: Diagnosis, indications, clinical and radiological follow-up
Stefano Colagrande, Francesco Regini, Gian Giacomo Taliani, Cosimo Nardi, Andrea Lorenzo Inghilesi
Stefano Colagrande, Francesco Regini, Gian Giacomo Taliani, Cosimo Nardi, Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Università degli Studi di Firenze-Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
Andrea Lorenzo Inghilesi, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze-Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
Author contributions: All authors contributed to this manuscript.
Supported by Protocollo TESORM by Regione Toscana, Università degli Studi di Firenze and Bayer Health Care s.p.a.
Conflict-of-interest: None.
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: Stefano Colagrande, MD, Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Università degli Studi di Firenze-Azienda Ospedaliero-Universitaria Careggi, Radiodiagnostica 2, Largo Brambilla 3, 50134 Florence, Italy. stefano.colagrande@unifi.it
Telephone: +39-055-7947189 Fax: +39-055-431970
Received: October 29, 2014
Peer-review started: November 1, 2014
First decision: December 12, 2014
Revised: December 27, 2014
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: May 18, 2015
Processing time: 202 Days and 17.4 Hours
Abstract

Advanced stage hepatocellular carcinoma (HCC) is a category of disease defined by radiological, clinical and hepatic function parameters, comprehending a wide range of patients with different general conditions. The main therapeutic option is represented by sorafenib treatment, a multi-kinase inhibitor with anti-proliferative and anti-angiogenic effect. Trans-arterial Radio Embolization also represents a promising new approach to intermediate/advanced HCC. Post-marketing clinical studies showed that only a portion of patients actually benefits from sorafenib treatment, and an even smaller percentage of patients treated shows partial/complete response on follow-up examinations, up against relevant costs and an incidence of drug related adverse effects. Although the treatment with sorafenib has shown a significant increase in mean overall survival in different studies, only a part of patients actually shows real benefits, while the incidence of drug related significant adverse effects and the economic costs are relatively high. Moreover, only a small percentage of patients also shows a response in terms of lesion dimensions reduction. Being able to properly differentiate patients who are responding to the therapy from non-responders as early as possible is then still difficult and could be a pivotal challenge for the future; in fact it could spare several patients a therapy often difficult to bear, directing them to other second line treatments (many of which are at the moment still under investigation). For this reason, some supplemental criteria to be added to the standard modified Response Evaluation Criteria in Solid Tumors evaluation are being searched for. In particular, finding some parameters (cellular density, perfusion grade and enhancement rate) able to predict the sensitivity of the lesions to anti-angiogenic agents could help in stratifying patients in terms of treatment responsiveness before the beginning of the therapy itself, or in the first weeks of sorafenib treatment. This would bring a strongly desirable help in clinical managements of these patients.

Keywords: Modified Response Evaluation Criteria in Solid Tumors; Diffusion weighted imaging; Barcelona clinic liver cancer; Advanced hepatocellular carcinoma; Sorafenib; Advanced hepatocellular carcinoma second line therapies; Perfusion weighted imaging; Response evaluation; Hepatocellular carcinoma follow-up; Response Evaluation Criteria in Solid Tumors

Core tip: Advanced stage hepatocellular carcinoma comprehends a wide range of patients with different general conditions. The main therapeutic option is represented by sorafenib. Although the treatment has shown a significant increase in mean overall survival, only a part of patients actually shows benefits. Differentiating responder from non-responder patients is a pivotal challenge for the future. In particular, finding parameters quantitatively describing perfusion grade, and then able to predict the sensitivity of the lesions to anti-angiogenic agents could help stratifying patients in terms of responsiveness before the beginning of the therapy itself. This would bring a great help in management of these patients.