Therapy of Primary Liver Cancer

Abstract

Primary liver cancer (PLC) is a fatal disease that affects millions of lives worldwide. PLC is the leading cause of cancer-related deaths and the incidence rate is predicted to rise in the coming decades. PLC can be categorized into three major histological subtypes: hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined HCC-ICC. These subtypes are distinct with respect to epidemiology, clinicopathological features, genetic alterations, and clinical managements, which are thoroughly summarized in this review. The state of treatment strategies for each subtype, including the currently approved drugs and the potential novel therapies, are also discussed.

Keywords: PLC therapy; combined HCC-ICC; hepatocellular carcinoma; intrahepatic cholangiocarcinoma; primary liver cancer.

Graphical abstract

Figure 1

Barcelona Clinic Liver Cancer Staging System and Corresponding Treatment Options. The schematic diagram illustrates therapeutic choice by which a treatment theoretically recommended for a different stage is the best treatment option. 1L, first-line; 2L, second-line; ECOG, Eastern Cooperative Oncology Group; M, metastasis stage; N, nodal stage; PEI, percutaneous ethanol injection; PS, performance status; T, tumor stage; TACE, transarterial chemoembolization; TARE, transarterialradioembolization; Y-90, Y-90 radioembolization

Figure 2

Treatment Strategy for Advanced HCC and ICC. The schematic illustration represents FDA-approved drugs for treatment of advanced HCC and ICC. First-line drugs for HCC include sorafenib, lenvatinib, atezolizumab plus bevacizumab, tremelimumab plus durvalumab and donafenib, whereas, for ICC, the combination of gemcitabine and cisplatin is currently proposed as first line. The bottom row represents corresponding second-line therapies that come in when patients are not suitable for their first-line therapy.