Supportive care in hepatocellular carcinoma

Background. Treatment options in patients with advanced hepatocellular carcinoma (HCC) after failure of systemic treatment with sorafenib are currently still very restricted. Liver failure is the most common cause of death in HCC patients and can only be treated supportively. In this situation, best supportive care (BSC) is the accepted standard. Methods. This study is based on a selective PubMed search for supportive care in HCC. Results. BSC in HCC is not well defined in the literature and current practice guidelines. Only treatment of pruritus is defined. Most patients with advanced HCC will develop symptoms of liver failure (ascites, clotting disorders, bleeding complications, edema, and others). Classical tumor-associated symptoms such as pain and malnutrition are observed during disease progression. For pain management, acetaminophen or, if indicated, opioids are preferred. Malignant portal vein thrombosis is typical for HCC; however, adequate treatment is controversial. Relatively rare complications are cholestasis and cholangitis, as well as symptomatic bone and lung metastases. Conclusion. This review summarizes the current literature and practice guidelines concerning supportive care in patients with advanced HCC.