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Gomaa et al. Hepatoma Res 2017;3:112-22 Hepatoma Research
DOI: 10.20517/2394-5079.2017.03
www.hrjournal.net
Review Open Access

Management of advanced hepatocellular

carcinoma: review of current and potential

therapies

Asmaa Gomaa, Imam Waked

Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 32111, Egypt.

Correspondence to: Dr. Asmaa Gomaa, National Liver Institute, Menoufiya University, Shebeen El-Kom 32111, Egypt. E-mail: aibrahim@liver-eg.org
How to cite this article: Gomaa A, Waked I. Management of advanced hepatocellular carcinoma: review of current and potential therapies. Hepatoma
Res 2017;3:112-22.

ABSTRACT
Article history: Over the past few years, despite improvement in screening and diagnosis of hepatocellular
Received: 17-01-2017 carcinoma (HCC), advanced stage remains the most common presentation at diagnosis, with
Accepted: 27-04-2017 limited management options, especially options available to patients in limited resource
Published: 15-06-2017 countries. There is currently no effective systemic chemotherapy, targeted, or immunologic
therapy for advanced stage HCC. Sorafenib is the only approved front-line molecular-
Key words: targeted treatment, with slight survival benefit. Regorafenib has recently been approved as
Hepatocellular carcinoma, second line therapy for HCC after failure of sorafenib. Ongoing research on molecular agents
advanced stage, targeting different pathways, combination therapies, and immunotherapy, represent hope for
molecular targeted agents, new treatment modalities. This manuscript reviews current treatment, ongoing research, and
sorafenib, potential future treatments for advanced HCC.
immune therapy

INTRODUCTION are more effective than sorafenib, or combinations
of therapy that might improve response and survival
Hepatocellular carcinoma (HCC) is the second rates in patients with advanced HCC. Results of trials
leading cause of cancer-related death globally, with with lenvatinib as first-line or regorafenib as second
about 800,000 deaths every year. [1] Unfortunately, line treatments are promising. Radioembolisation
[3]
considerable number of patients are diagnosed is as safe and effective in advanced-stage HCC as
at advanced stage unsuitable for surgery or local first-line or second-line therapy. In addition, the
[4]
treatment with poor prognosis and a median overall use of immunotherapy in clinical trials demonstrated
survival (OS) of about 6 months. Molecular targeted promising results. This manuscript reviews the
[5]
therapies have demonstrated promising efficacy current treatments and ongoing research for therapy
in the management of cancer. Sorafenib improves of advanced HCC.
[2]
survival with median OS rate of 6.5-10.7 months,
with significant benefit in time to progression, despite ADVANCED HCC
the absence of objective response. Numerous trials
are ongoing in search for other molecular agents that Despite advances in screening and diagnosis, most
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