6533b7d5fe1ef96bd1265172

RESEARCH PRODUCT

Transarterial chemoembolization and sorafenib in patients with intermediate-stage hepatocellular carcinoma: time to enter routine clinical practice?

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description

According to the guidelines of the European Association for the Study of the Liver (EASL), patients affected from hepatocellular carcinoma (HCC) can be classified according to the Barcelona Clinic Liver Cancer (BCLC) staging system. This classification system divides HCC patients in five stages (0, A, B, C and D) on the basis of a number of prognostic and treatment- related variables such as tumor status and liver function. A specific treat ment approach is then proposed for each of the above-mentioned stages. Transarterial chemoembolization (TACE) is recommended as first-line therapy in the treatment of patients with intermediate-stage (BCLC-B class) HCC [1]. The efficacy of this procedure is supported by robust data [2,3]. Despite its efficacy, however, there is still a lack of standardization in treatment methodology, and TACE protocols are widely variable both in terms of dosages and schedule (on demand vs fixed interval administration) [4]. Moreover, the longterm outcomes of patients managed with TACE are not fully satisfactory, with up to 80% of patients eventually showing tumor progression [5] and TACE can be associated with a number of contraindications [4]. Of note, patients with BCLC-B HCC present highly heterogenic features, and therefore the behavior of intermediate-stage HCC patients is difficult to anticipate [6,7]. This heterogeneity is due to a number of characteristics including performance status, Child-Pugh class and presence of portal vein thrombosis. Therefore, the development of an effective treatment strategy for all patients with BCLC-B HCC does not appear to be an easy task: a tailored approach to optimize the clinical outcomes in each single patient is needed [8]. Treatment options different from TACE, such as surgery, local ablation, radioembolization or systemic therapy, may be effective in patients with intermediate- stage HCC, and research in this filed appears quite active [8]. One of the most promising treatment options is the combination of different therapies [8,9]. Sorafenib, an oral multityrosine kinase inhibitor, is the only systemic therapy to be approved in patients with HCC [10]. Current guidelines and expert opinions recommend the use of sorafenib in patients