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Review
. 2019 Mar 18;1(1):17-29.
doi: 10.1016/j.jhepr.2019.02.003. eCollection 2019 May.

Controversies in the management of hepatocellular carcinoma

Alejandro Forner  1   2 , Leonardo G Da Fonseca  1 , Álvaro Díaz-González  1 , Marco Sanduzzi-Zamparelli  1 , María Reig  1   2 , Jordi Bruix  1   2
Affiliations
Review

Controversies in the management of hepatocellular carcinoma

Alejandro Forner et al. JHEP Rep. .

Abstract

The management of hepatocellular carcinoma (HCC) has evolved considerably over the last decade. Surveillance of cirrhotic patients and refinements to imaging techniques have enabled a relevant proportion of patients to be diagnosed at an early stage, when effective therapies are feasible. Resection, transplantation and ablation are all options in patients with early stage HCC. Thus, there is some controversy regarding which is the best treatment approach in challenging scenarios. There have also been major developments in locoregional therapies, particularly in intra-arterial approaches. Finally, the systemic treatment for HCC has changed dramatically following the demonstration of a survival benefit with sorafenib; there are currently several first-line (sorafenib and lenvatinib) and second-line (regorafenib, cabozantinib and ramucirumab) treatments that have shown a survival benefit. Expectations for immune checkpoint inhibitors are high, with the results of the ongoing phase III trials eagerly awaited. In this review we discuss some of the controversies in the management of HCC, focussing in particular on systemic therapy.

Keywords: Diagnosis; Hepatocelullar carcinoma; Liver transplantation; Locoregional therapy; Surgery; Systemic therapy.

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