Spectrum of therapeutic options in hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is a prevalent cancer with high mortality rates globally. This review explores various HCC treatments, including surgical resection, liver transplantation, local ablation, and systemic therapies. With advancements in surgical techniques, local therapies, and immunotherapy, the treatment paradigm for HCC is rapidly evolving. Surgical resection remains the preferred first-line treatment for localized HCC with preserved liver function, offering significant survival benefits. Liver transplantation is suitable for patients meeting specific criteria and helps restore liver function in individuals with compromised liver capabilities, providing excellent long-term outcomes. Local ablation is recommended for very early-stage HCC ineligible for surgery, offering outcomes comparable to resection. Transarterial therapies, such as transarterial radioembolization, are employed to treat intermediate-stage HCC, enhancing treatment outcomes. Radiation therapy is increasingly utilized due to improved safety profiles, providing effective treatment options for HCC patients. Systemic treatments have advanced with the introduction of molecularly targeted therapies and immune checkpoint inhibitors, improving survival rates. The development of immunotherapy combinations has shown promising efficacy as first-line treatments. The ongoing advancement in treatment strategies, alongside personalized patient approaches, is expected to further enhance outcomes for HCC patients.

Keywords: Hepatocellular carcinoma; Local ablation; Radiation therapy; Surgery; Systemic treatment; Transarterial therapy.

Fig. 1

Approved systemic therapeutics for advanced hepatocellular carcinoma. ICI, immune checkpoint inhibitors.