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Management of non-resectable hepatocellular carcinoma: recent advances

Hépato-Gastro. Volume 15, Number 6, 457-63, Novembre-Décembre 2008, Mini-revue

DOI : 10.1684/hpg.2008.0263

Résumé

Summary

Author(s) : Jean-Luc Raoul , Département d’oncologie médicale, centre E.-Marquis, CS 44229, 35042 Rennes cedex, France.

Summary : Palliative treatment of hepatocellular carcinoma is undergoing dramatic changes. Effectiveness of chemoembolization has been much debated, but new techniques of drug delivery could make its results more reproducible. New techniques making use of radioactive isotopes seem promising. The most encouraging results come from targeted therapies taking advantage of a better understanding of the tumors molecular biology. For the first time a novel systemic therapy, sorafenib, a multitargeted tyrosine kinase inhibitor, has shown promising results. Sorafenib is only the first in a long list of promising molecules and clinical trials are underway to extend its use to non-palliative treatment. The appearance of these new drugs will require renewed use of hepatic biopsy (to identify molecular predictive factors of treatment response), management of new adverse effects, development of new parameters to monitor efficacy and setting new guidelines for stopping the therapy. All this is a strong incentive to quickly include more of our patients in clinical trials.

Keywords : hepatocellular carcinoma, palliative setting, advanced stages

Pictures

Figure 1 Examen tomodensitométrique à la phase artérielle d’un patient ayant un CHC multifocal. A, B) Aspect avant la mise sous sorafenib ; C, D) coupes aux mêmes niveaux après un mois de sorafenib ; noter l’aspect largement hypovascularisé de la majorité des nodules tumoraux.

Figure 2 Syndrome main-pied sévère (grade 3) observé sous sorafenib : épaississement cutané et cloques responsables d’une impotence fonctionnelle devenant invalidante.