title: Current approach in the treatment of hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) is the most common malignant hepatobiliary disease; it is responsible for about 1 million deaths per year. Risk factors include hepatitis B and C, hepatic cirrhosis, including alcohol related hepatitis, metabolic and nutritional hepatic damage. The main modality of diffusion is intrahepatic in the natural course of the disease. There are two leading types of treatment: local and systemic. Surgical resection and liver transplantation constitute the most appropriate local treatments and are considered the only real possibility for recovery. Other local approaches include: radiofrequency ablation, percutaneous ethanol ablation, hepatic endoarterial chemoembolization and intrahepatic radiotherapy (SIRT: selective internal radiation therapy). These last treatments are used to control the disease when surgery or transplantation is not achievable; in some cases they are able to prolong survival while they constitute mainly a palliative treatment. Systemic treatments include: chemotherapy, immunological and hormonal therapies and, more recently, the introduction of new specific molecular target drugs. At the moment, in this group, the only drug that has given positive results during phase III trials (SHARP study) is Sorafenib. Sorafenib represents the only primary systemic therapy that has demonstrated, unlike the other treatments previously described, an increase in survival rate in patients affected with advanced HCC. Currently, other studies are taking place that are further developing the potential of this drug. These studies, including phase III trials, are directed in order to test the activity and safety of new emerging drugs with targeted activity. Examples of these new agents are: Sunitinib, Gefitinib, Cetuximab, Bevacizumab and Erlotinib.
authors.affiliation: Luigi Rossi, Federica Zoratto, Anselmo Papa, Marina Minozzi, Luigi Frati, Silverio Tomao, Department of Experimental Medicine, University of Rome "Sapienza", Viale Regina Elena 324, 00161 Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Rossi
authors.forename: Federica
authors.initials: F
authors.lastname: Zoratto
authors.forename: Anselmo
authors.initials: A
authors.lastname: Papa
authors.forename: Francesca
authors.initials: F
authors.lastname: Iodice
authors.forename: Marina
authors.initials: M
authors.lastname: Minozzi
authors.forename: Luigi
authors.initials: L
authors.lastname: Frati
authors.forename: Silverio
authors.initials: S
authors.lastname: Tomao