Loco-regional treatment of hepatocellular carcinoma in the era of molecular targeted therapies

Abstract

The treatment of hepatocellular carcinoma (HCC) is rapidly evolving as developments in loco-regional therapies continue to improve. Image-guided radiofrequency (RF) ablation is established as the treatment of choice for patients with early-stage HCC when transplantation or resection are precluded. Recent refinements in technique have substantially increased the ability of RF ablation to achieve sustained complete response of target tumors in properly selected patients, and new alternate thermal and non-thermal methods for local tumor treatment are currently under investigation. Transarterial chemoembolization (TACE) is the standard of care for patients with multinodular disease at the intermediate stage. The introduction of drug-eluting beads--that enhance drug delivery to the tumor and reduce systemic exposure--appears to improve anticancer activity and the safety profile of TACE compared to conventional regimens. Despite these advances, the long-term outcomes of patients treated with loco-regional therapies remain unsatisfactory because of the high rate of tumor recurrence. The introduction of molecular targeted therapies that inhibit tumor proliferation and angiogenesis has opened new prospects in this regard. Clinical trials focused on combining interventional treatment with systemically active drugs are ongoing. The outcomes of such studies are eagerly awaited, as they have the potential to revolutionize treatment of HCC.