Published online Jun 28, 2017. doi: 10.4254/wjh.v9.i18.797
Peer-review started: February 13, 2017
First decision: March 10, 2017
Revised: May 7, 2017
Accepted: May 12, 2017
Article in press: May 15, 2017
Published online: June 28, 2017
Processing time: 142 Days and 6.8 Hours
Hepatocellular carcinoma (HCC) is a common neoplasia which represents the second leading cause of cancer related death. Most cases occur in developing countries, but its incidence is rising in Western countries due to hepatitis C. Although hepatitis therapies have evolved and the HCC screening has increased in several areas, 40% present with advanced disease which is only amenable for palliative systemic treatment. HCC continues posing a challenge, in part due to the inherent chemoresistance of this neoplasia, the pharmacologic challenges due to an ill liver, difficulty in assessing radiological responses accurately, etc. Traditional chemotherapy have shown some responses without clear survival benefit, however, sorafenib demonstrated advantages in survival in advanced HCC when liver function is kept and recently immunotherapy seems to be a promising approach for some patients. This article will briefly expose the most relevant systemic treatment modalities to offer a general view from the past to the future.
Core tip: The incidence of hepatocellular carcinoma (HCC) is rising in Western countries due to hepatitis C. Unfortunately, 40% of patients present with advanced disease which is only amenable for palliative systemic treatment. The development of effective therapies for HCC is a challenge, due partly to its inherent chemoresistance, the pharmacologic challenges due to an ill liver, etc. Although some responses to traditional chemotherapy have been reported, the multikinase inhibitor sorafenib has shown survival benefit in advanced HCC with preserved liver function. Recently immunotherapy seems to be a promising approach for some patients.