Endocrine treatment of hepatocellular carcinoma. Any evidence of benefit?
In the past 20 years, a number of studies have investigated the relationship between sex hormones and liver cancer. Experimental studies indicate that a dynamic process, with sequential modifications in the pattern of sex hormones in the serum and of sex hormone receptors in the liver, occurs progressively during hepatocarcinogenesis. Overall, it seems that both androgens and oestrogens may enhance liver carcinogenesis, while androgens may also support the growth of established liver tumours. Unfortunately, clinical studies of endocrine treatment of hepatocellular carcinoma (HCC) have not adequately tested the suggestions from biological studies. So far, no clinical trial has been performed to test the efficacy of endocrine manipulation for the chemoprevention of HCC in cirrhotic patients nor in preventing relapse after radical resection of primary HCC. Anti-oestrogens have been the most studied agents for the endocrine treatment of established HCC, although the rationale that supports their use is weaker than for anti-androgens. Studies with anti-androgens have produced prevalently negative results, due to either a lack of activity or excessive toxicity. The use of chemical castration, which theoretically could enhance the activity of antihormonal compounds, yielded no benefit at all. In summary, there is, as yet, no definitive evidence that endocrine treatment favourably affects the outcome of patients with HCC.
Pignata
S
S
Istituto Nazionale dei Tumori, Napoli, Italy.
Daniele
B
B
Gallo
C
C
De Vivo
R
R
Monfardini
S
S
Perrone
F
F
D000818:Animals; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D012739:Gonadal Steroid Hormones / Q000037:antagonists & inhibitors*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D051381:Rats; D017208:Rats, Wistar; D011960:Receptors, Estrogen / Q000378:metabolism
D018931:Antineoplastic Agents, Hormonal; D012739:Gonadal Steroid Hormones; D011960:Receptors, Estrogen