Systemic therapy of hepatocellular carcinoma

For the early diagnosis of hepatocellular carcinoma (HCC) all patients with liver cirrhosis or chronic hepatitis B should undergo ultrasound examination every 6 months. For advanced stages without curative options (BCLC stages B and C) systemic therapy by oral administration of the tyrosine kinase inhibitor (TKI) sorafenib has been approved since 2007. In controlled trials, this substance has demonstrated a reduction in the risk to die early of about 30% and an improvement of approximately 3 months in the median overall survival. Sorafenib induces many side effects and is frequently not tolerated by patients with decompensated cirrhosis (Child-Pugh B). The most relevant side effects are skin toxicities, diarrhea, fatigue and hypertension. In many cases, early supportive management of side effects and prophylactic measures, in particular patient education and skin care, prevent higher grade toxicity. Clinical data do currently not support the use of standard chemotherapeutic agents and monoclonal antibodies in the monotherapy of HCC. In current clinical trials, alternative TKI and combination therapies with sorafenib are being tested.