Advances in the treatment of hepatocellular carcinoma: An overview of the current and evolving therapeutic landscape for clinicians.

Hepatocellular carcinoma (HCC) is the sixth most common malignancy and the third leading cause of cancer-related death worldwide. Contemporary advances in systemic and locoregional therapies have led to changes in peer-reviewed guidelines regarding systemic therapy as well as the possibility of downstaging disease that may enable some patients with advanced disease to ultimately undergo partial hepatectomy or transplantation with curative intent. This review focuses on all modalities of therapy for HCC, guided by modern-day practice-changing randomized data where available. The surgical management of HCC, including resection and transplantation, both of which have evolving criteria for what is considered biologically resectable and transplantable, as well as locoregional therapy (i.e., therapeutic embolization, ablation, radiation, and hepatic arterial infusion), are discussed. Historical and modern-day practice-changing trials evaluating immunotherapy with targeted therapies for advanced disease, as well as adjuvant systemic therapy, are also summarized. In addition, this article examines the critical dimension of toxicities and patient-oriented considerations to ensure a comprehensive and balanced discourse on treatment implications.

Duke Scholars

Author Peter Allen Surgical Oncology

Author Mustafa Shadi Rifaat Bashir Radiology, Abdominal Imaging

Author Carl Berg Medicine, Gastroenterology

Author Michael Aaron Morse Medicine, Medical Oncology

Author Manisha Palta Radiation Oncology

Author Alessandro Martinino  

Author Andrew Serghios Barbas Surgery, Abdominal Transplant Surgery

Author Debra L Sudan Surgery, Abdominal Transplant Surgery

Author Charles Yoon Kim Radiology, Interventional Radiology

Author Michael Evan Lidsky Surgical Oncology