Chemopreventive strategies in hepatocellular carcinoma.
Hepatocellular carcinoma (HCC) is the third most common cause of death from cancer. The incidence and mortality of HCC are increasing in most Western countries as a result of an ageing cohort infected with chronic hepatitis C, and are expected to continue to rise as a consequence of the obesity epidemic. Chemopreventive strategies aimed at decreasing the risk or delaying the onset of HCC are needed. Universal immunization against HBV and antiviral therapy against HBV and HCV in patients with established disease has consistently been associated with reduced HCC risk, especially in patients who achieve sustained virologic response. However, the cost-effectiveness of antiviral therapy for primary HCC prevention is not known. Several commonly prescribed medications seem promising as chemopreventive agents against HCC, including statins, antidiabetic medications and aspirin. Dietary agents such as coffee, vitamin E and fish oil as well as phytochemicals might also be associated with reduced risk of HCC. Though randomized controlled trials are ideally needed to firmly establish efficacy, such chemoprevention trials are logistically and ethically challenging. Well-designed, prospective, population-based cohort studies might provide the best evidence for chemopreventive efficacy of these agents.
Division of Gastroenterology and Hepatology, 200 First Street SW, Rochester, MN 55905, USA.
Siddharth
S
Singh
Department of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Preet Paul
PP
Singh
Division of Gastroenterology and Hepatology, 200 First Street SW, Rochester, MN 55905, USA.
Lewis R
LR
Roberts
Division of Gastroenterology and Hepatology, 200 First Street SW, Rochester, MN 55905, USA.
William
W
Sanchez
D000998:Antiviral Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D018890:Chemoprevention / Q000379:methods*; D006505:Hepatitis / Q000150:complications / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors
D000998:Antiviral Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D001241:Aspirin