title: Current and future treatments for hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) represents a unique challenge for physicians and patients. There is no definitively curative treatment. Rather, many treatment and management modalities exist with differing advantages and disadvantages. Both current guidelines and individual patient concerns must be taken into account in order to properly manage HCC. In addition, quality of life issues are particularly complex in patients with HCC and these concerns must also be factored into treatment strategies. Thus, considering all the options and their various pros and cons can quickly become complex for both clinicians and patients. In this review, we systematically discuss the current treatment modalities available for HCC, detailing relevant clinical data, risks and rewards and overall outcomes for each approach. Surgical options discussed include resection, transplantation and ablation. We also discuss the radiation modalities: conformal radiotherapy, yttrium 90 microspheres and proton and heavy ion radiotherapy. The biologic agent Sorafenib is discussed as a promising new approach, and recent clinical trials are reviewed. We then detail currently described molecular pathways implicated in the initiation and progression of HCC, and we explore the potential of each pathway as an avenue for drug exploitation. We hope this comprehensive and forward-looking review enables both clinicians and patients to understand various options and thereby make more informed decisions regarding this disease.
authors.affiliation: Alexander Schlachterman, Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schlachterman
authors.affiliation: Alexander Schlachterman, Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States.
authors.forename: Willie W
authors.initials: WW
authors.lastname: Craft
authors.affiliation: Alexander Schlachterman, Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States.
authors.forename: Eric
authors.initials: E
authors.lastname: Hilgenfeldt
authors.affiliation: Alexander Schlachterman, Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States.
authors.forename: Avir
authors.initials: A
authors.lastname: Mitra
authors.affiliation: Alexander Schlachterman, Department of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, Gainesville, FL 32608, United States.
authors.forename: Roniel
authors.initials: R
authors.lastname: Cabrera
mesh_terms: D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000235:genetics / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055088:Early Detection of Cancer; D006801:Humans; D008113:Liver Neoplasms / Q000235:genetics / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D010166:Palliative Care; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Adult; Hepatic neoplasm; Hepatocellular cancer; Hepatocellular carcinoma; Hepatoma; Liver cancer; Liver cell carcinoma; Liver neoplasm