International Liver Cancer Course 2024

Post: Insights in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a prototypical inflammation-associated cancer and remains a leading contributor of cancer-related fatalities. The typical progression of the disease follows a trajectory from liver injury and chronic inflammation to fibrosis, cirrhosis, and finally, HCC. Various risk factors contribute to the onset of HCC, including viral infections, alcohol consumption, NAFLD, exposure to aflatoxins and genetic predisposition. Management of HCC hinges upon the disease’s stage and underlying conditions. For early-stage cases, viable options encompass surgical resection, Radio-Frequency Ablation, Trans-Arterial Chemoembolization, or liver transplantation. However, in the advanced stages, conversion therapy emerges as a potential recourse. Conversion therapy involves transforming advanced, unresectable liver cancer into a resectable form through local treatments like transarterial chemoembolization (TACE), systemic treatments like targeted therapy either individually or in conjunction with immunotherapy, and a therapeutic alliance comprising of strategies such as combining TACE with radiation therapy or targeted therapy. Systemic administration of tyrosine kinase inhibitors such as Lenvatinib, Cabozantinib, and Regorafenib has also shown promise. Notably, recent FDA approvals include Atezolizumab and bevacizumab and monoclonal antibodies for patients with unresectable HCC. Addressing pressing clinical challenges involves pinpointing distinctive markers of drug sensitivity and identifying patient cohorts that exhibit positive responses to specific treatments. New trials are exploring the efficacy of combination therapies, including checkpoint inhibitors and tyrosine kinase inhibitors. A combinations of two immunotherapy regimens is also being investigated and appear to be promising in changing the landscape of the disease management in all stages.

INSIGHTS IN HEPATOCELLULAR CARCINOMA

Dr. Dinesh Mani Tripathi,
Institute of Liver and Biliary Sciences, Delhi India

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