title: Moving towards personalised therapy in patients with hepatocellular carcinoma: the role of the microenvironment.
abstract: The goal of personalised therapy based on hepatocellular carcinoma (HCC) molecular characteristics is still beyond our grasp. Systemic treatments show poor efficacy, mainly because of the great heterogeneity of the tumour. Indeed, differences in aetiology, disease stage and biochemical composition of the fibrotic liver make cirrhosis itself a highly dyshomogeneous disease. Cancer cells grow in a cirrhotic microenvironment, interacting with stromal cells and engaging matrix components that differ from patient to patient, hampering the development of drugs to treat all patients. Growing evidence suggests a role for the cross-talk between HCC and the host stroma in driving disease progression and hence prognosis and survival. Many efforts have been devoted to identifying genes responsible for good or bad prognosis, but no study has yet proven helpful in guiding therapeutic choices and management over time, also taking into account the development of drug resistance. The questions of what to target and in which patient are still unsolved. In the personalised therapy scenario, the patient rather than the disease becomes the target of the therapy. However, this still requires an evidence-based medical approach. Herein, we will discuss how individual differences in terms of quality and quantity of the tissue microenvironment components affect progression of HCC. Then, we will highlight potential druggable pathways, also considering ongoing clinical trials. The development of biomarkers will be discussed in the light of new experimental research conducted with the aim of moving towards personalised therapy in patients with HCC.
authors: Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors: Gianluigi
authors: G
authors: Giannelli
authors: Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors: Bhavna
authors: B
authors: Rani
authors: Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors: Francesco
authors: F
authors: Dituri
authors: Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors: Yuan
authors: Y
authors: Cao
authors: Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy.
authors: Giuseppe
authors: G
authors: Palasciano
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D018450:Disease Progression; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D057285:Precision Medicine / Q000379:methods*; D059016:Tumor Microenvironment
keywords: HEPATOCELLULAR CARCINOMA; TGF-BETA