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Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jun 10, 2017; 8(3): 203-213
Published online Jun 10, 2017. doi: 10.5306/wjco.v8.i3.203
Evolving role of Sorafenib in the management of hepatocellular carcinoma
Ioannis A Ziogas, Georgios Tsoulfas
Ioannis A Ziogas, Aristotle University of Thessaloniki School of Medicine, 54124 Thessaloniki, Greece
Georgios Tsoulfas, 1st Department of Surgery, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece
Author contributions: Ziogas IA and Tsoulfas G contributed equally to this work.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
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: Georgios Tsoulfas, MD, PhD, FACS, Assistant Professor of Surgery, 1st Department of Surgery, Aristotle University of Thessaloniki, 66 Tsimiski Street, 56403 Thessaloniki, Greece. tsoulfasg@gmail.com
Telephone: +30-6971-895190 Fax: +30-2310-332022
Received: January 28, 2017
Peer-review started: February 10, 2017
First decision: March 27, 2017
Revised: April 3, 2017
Accepted: April 23, 2017
Article in press: April 25, 2017
Published online: June 10, 2017
Processing time: 125 Days and 0.2 Hours
Abstract

Hepatocellular carcinoma (HCC) is one of the most common malignant diseases worldwide and comes third in cancer-related mortality. Although there is a broad spectrum of treatment options to choose from, only a few patients are eligible candidates to receive a curative therapy according to their stage of disease, and thus palliative treatment is implemented in the majority of the patients suffering from liver cancer. Sorafenib, a multikinase inhibitor, is the only currently approved agent for systemic therapy in patients with advanced stage HCC and early stage liver disease. It has been shown to improve the overall survival, but with various side effects, while its cost is not negligible. Sorafenib has been in the market for a decade and has set the stage for personalized targeted therapy. Its role during this time has ranged from monotherapy to neoadjuvant and adjuvant treatment with surgical resection, liver transplantation and chemoembolization or even in combination with other chemotherapeutic agents. In this review our aim is to highlight in depth the current position of Sorafenib in the armamentarium against HCC and how that has evolved over time in its use either as a single agent or in combination with other therapies.

Keywords: Sorafenib; Hepatocellular carcinoma; Liver neoplasm; Multikinase inhibitor; Targeted therapy; Tumor angiogenesis; Signaling pathways; Adjuvant therapy; Liver cancer; Liver transplantation; Liver resection

Core tip: Hepatocellular carcinoma (HCC) is an aggressive and invasive malignancy. Curative options, such as resection and liver transplantation, are limited to only a few patients, who are suitable candidates. Sorafenib is the only approved systemic treatment in HCC, especially for advanced tumor stage and early stage liver disease. Recent findings suggest that it may also be helpful in carefully selected decompensated patients. Its adjuvant role is yet to be proven with more promising results. The combination of Sorafenib with other chemotherapy agents has shown improved efficacy and safety. We aim to present the evolution of Sorafenib’s use over the last decade.