Unresectable hepatocellular carcinoma: new opportunities and prospects for therapy

Abstract

Hepatocellular carcinoma (HCC) is the most common liver malignancy and ranks sixth for cancer prevalence and fourth place among the causes of cancer mortality. Despite the improvement of diagnostic techniques, the diagnosis of HCC is still determined in the late stages. The absence of screening programs in groups of risk of HCC (cirrhosis) and the late diagnosis of HCC show the mortality rate exceeds incidence rate in the Russian Federation. It is important to improve the diagnostic methods for early detection of HCC and to use the multidisciplinary approach in diagnosis and treatment of HCC in association with different specialists (hepatologist, oncologist, chemotherapist, surgeon, transplantologist, interventional radiologist). Systemic therapy should be used in all patients with unresectable HCC and compensated liver function. Since 2007 sorafenib has represented the only approved drug for treatment of unresectable HCC. In 2017, according to the results of REFLECT trial lenvatinib was registered for the treatment of unresectable HCC in the first line therapy. For the first time in the last 10 years the efficiency of lenvatinib application in comparison with sorafenib was practically the same, concerning the overall survival rate. Lenvatinib also demonstrated the statistically significant and clinically meaningful benefit in terms of improvement of survival without progression, the time to progression and frequency of objective response rate compared with sorafenib.

Keywords

• hepatocellular carcinoma
• cirrhosis of the liver
• screening
• a multidisciplinary approach
• bclc staging classification
• systemic therapy for hepatocellular carcinoma
• reflect trial
• lenvatinib