Hepatocellular carcinoma: consensus recommendations of the National Cancer Institute Clinical Trials Planning Meeting

Melanie B Thomas, Deborah Jaffe, Michael M Choti, Jacques Belghiti, Steven Curley, Yuman Fong, Gregory Gores, Robert Kerlan, Phillipe Merle, Bert O'Neil, Ronnie Poon, Lawrence Schwartz, Joel Tepper, Francis Yao, Daniel Haller, Margaret Mooney, Alan Venook, Melanie B Thomas, Deborah Jaffe, Michael M Choti, Jacques Belghiti, Steven Curley, Yuman Fong, Gregory Gores, Robert Kerlan, Phillipe Merle, Bert O'Neil, Ronnie Poon, Lawrence Schwartz, Joel Tepper, Francis Yao, Daniel Haller, Margaret Mooney, Alan Venook

Abstract

Hepatocelluar carcinoma (HCC) is the most common primary malignancy of the liver in adults and the third most common cause of cancer death worldwide. The incidence of HCC in the United States is rising steadily because of the prevalence of hepatitis C viral infection and other causes of hepatic cirrhosis. The majority of patients have underlying hepatic dysfunction, which complicates patient management and the search for safe and effective therapies. The Clinical Trials Planning Meeting (CTPM) in HCC was convened by the National Cancer Institute's Gastrointestinal Cancer Steering Committee to identify the key knowledge gaps in HCC and define clinical research priorities. The CTPM structured its review according to current evidence-based treatment modalities in HCC and prioritized the recommendations on the basis of the patient populations representing the greatest unmet medical need.

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
General treatment algorithm for hepatocellular carcinoma. *Suitability of patients with Child-Pugh class B cirrhosis for surgical resection is highly controversial. PVE, portal vein embolization; mets, metastasis; TACE, transcatheter arterial chemoembolization; ETOH, ethanol; RFA, radiofrequency ablation; PEI, percutaneous ethanol injection.

References

    1. Jemal A, Ward E, Hao Y, et al. Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005;294:1255–1259.
    1. Bosch FX, Ribes J, Díaz M, et al. Primary liver cancer: Worldwide incidence and trends. Gastroenterology. 2004;127:S5–S16.
    1. Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010;116:544–573.
    1. Kim WR. Epidemiology of hepatitis B in the United States. Hepatology. 2009;49:S28–S34.
    1. Bialecki ES, Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford) 2005;7:26–34.
    1. Clark HP, Carson WF, Kavanagh PV, et al. Staging and current treatment of hepatocellular carcinoma. Radiographics. 2005;25(suppl 1):S3–S23.
    1. Palavecino M, Chun YS, Madoff DC, et al. Major hepatic resection for hepatocellular carcinoma with or without portal vein embolization: Perioperative outcome and survival. Surgery. 2009;145:399–405.
    1. Colombo M. Hepatitis C virus and hepatocellular carcinoma. Semin Liver Dis. 1999;19:263–269.
    1. Chu CM, Liaw YF. Hepatitis B virus-related cirrhosis: Natural history and treatment. Semin Liver Dis. 2006;26:142–152.
    1. Perz JF, Armstrong GL, Farrington LA, et al. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45:529–538.
    1. Saab S, Yeganeh M, Nguyen K, et al. Recurrence of hepatocellular carcinoma and hepatitis B reinfection in hepatitis B surface antigen-positive patients after liver transplantation. Liver Transpl. 2009;15:1525–1534.
    1. Tong MJ, Hsien C, Song JJ, et al. Factors associated with progression to hepatocellular carcinoma and to death from liver complications in patients with HBsAg-positive cirrhosis. Dig Dis Sci. 2009;54:1337–1346.
    1. Schütte K, Bornschein J, Malfertheiner P. Hepatocellular carcinoma: Epidemiological trends and risk factors. Dig Dis. 2009;27:80–92.
    1. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med. 1999;340:745–750.
    1. Chiaramonte M, Stroffolini T, Vian A, et al. Rate of incidence of hepatocellular carcinoma in patients with compensated viral cirrhosis. Cancer. 1999;85:2132–2137.
    1. Marrero JA, Fontana RJ, Su GL, et al. NAFLD may be a common underlying liver disease in patients with hepatocellular carcinoma in the United States. Hepatology. 2002;36:1349–1354.
    1. Chávez-Tapia NC, Méndez-Sánchez N, Uribe M. Role of nonalcoholic fatty liver disease in hepatocellular carcinoma. Ann Hepatol. 2009;8(suppl 1):S34–S39.
    1. Siegel AB, Zhu AX. Metabolic syndrome and hepatocellular carcinoma: Two growing epidemics with a potential link. Cancer. 2009;115:5651–5661.
    1. Page JM, Harrison SA. NASH and HCC. Clin Liver Dis. 2009;13:631–647.
    1. Jaskiewicz K, Banach L, Lancaster E. Hepatic siderosis, fibrosis and cirrhosis: The association with hepatocellular carcinoma in high-risk population. Anticancer Res. 1997;17:3897–3899.
    1. Budhu A, Forgues M, Ye QH, et al. Prediction of venous metastases, recurrence, and prognosis in hepatocellular carcinoma based on a unique immune response signature of the liver microenvironment. Cancer Cell. 2006;10:99–111.
    1. Honda H, Tajima T, Kajiyama K, et al. Vascular changes in hepatocellular carcinoma: Correlation of radiologic and pathologic findings. AJR Am J Roentgenol. 1999;173:1213–1217.
    1. Roncalli M, Borzio M, Di Tommaso L. Hepatocellular dysplastic nodules. Ann Ital Chir. 2008;79:81–89.
    1. Shinmura R, Matsui O, Kadoya M, et al. Detection of hypervascular malignant foci in borderline lesions of hepatocellular carcinoma: Comparison of dynamic multi-detector row CT, dynamic MR imaging and superparamagnetic iron oxide-enhanced MR imaging. Eur Radiol. 2008;18:1918–1924.
    1. Kitamura T, Ichikawa T, Erturk SM, et al. Detection of hypervascular hepatocellular carcinoma with multidetector-row CT: Single arterial-phase imaging with computer-assisted automatic bolus-tracking technique compared with double arterial-phase imaging. J Comput Assist Tomogr. 2008;32:724–729.
    1. Kim MJ, Choi JY, Chung YE, et al. Magnetic resonance imaging of hepatocellular carcinoma using contrast media. Oncology. 2008;75(suppl 1):72–82.
    1. Therasse P, Eisenhauer EA, Verweij J. RECIST revisited: A review of validation studies on tumour assessment. Eur J Cancer. 2006;42:1031–1039.
    1. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1) Eur J Cancer. 2009;45:228–247.
    1. Kharuzhyk S, Fabel M, von Tengg-Kobligk H, et al. Image-based evaluation of tumor response to treatment: Where is radiology today? Exp Oncol. 2008;30:181–189.
    1. Choi BI. Hepatocarcinogenesis in liver cirrhosis: Imaging diagnosis. J Korean Med Sci. 1998;13:103–116.
    1. Menu Y. [Evaluation of tumour response to treatment with targeted therapies: Standard or targeted criteria?] Bull Cancer. 2007;94:F231–F239.
    1. Lu W, Dong J, Huang Z, et al. Comparison of four current staging systems for Chinese patients with hepatocellular carcinoma undergoing curative resection: Okuda, CLIP, TNM and CUPI. J Gastroenterol Hepatol. 2008;23:1874–1878.
    1. Cho CS, Gonen M, Shia J, et al. A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma. J Am Coll Surg. 2008;206:281–291.
    1. Georgiades CS, Liapi E, Frangakis C, et al. Prognostic accuracy of 12 liver staging systems in patients with unresectable hepatocellular carcinoma treated with transarterial chemoembolization. J Vasc Interv Radiol. 2006;17:1619–1624.
    1. Collette S, Bonnetain F, Paoletti X, et al. Prognosis of advanced hepatocellular carcinoma: Comparison of three staging systems in two French clinical trials. Ann Oncol. 2008;19:1117–1126.
    1. Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC Cancer Staging Manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–1474.
    1. Vauthey JN, Lauwers GY, Esnaola NF, et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol. 2002;20:1527–1536.
    1. Gunderson LL, Jessup JM, Sargent DJ, et al. Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol. 2010;28:256–263.
    1. Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: The BCLC staging classification. Semin Liver Dis. 1999;19:329–338.
    1. Lucey MR, Brown KA, Everson GT, et al. Minimal criteria for placement of adults on the liver transplant waiting list: A report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. 1997;3:628–637.
    1. Pugh RC. Proceedings: The pathology of cancer of the bladder. Cancer. 1973;32:1267–1274.
    1. Prospective validation of the CLIP score A new prognostic system for patients with cirrhosis and hepatocellular carcinoma—The Cancer of the Liver Italian Program (CLIP) Investigators. Hepatology. 2000;31:840–845.
    1. Leung TW, Tang AM, Zee B, et al. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: A study based on 926 patients. Cancer. 2002;94:1760–1769.
    1. Cammà C, Di Marco V, Cabibbo G, et al. Survival of patients with hepatocellular carcinoma in cirrhosis: A comparison of BCLC, CLIP and GRETCH staging systems. Aliment Pharmacol Ther. 2008;28:62–75.
    1. Makuuchi M, Belghiti J, Belli G, et al. IHPBA concordant classification of primary liver cancer: Working group report. J Hepatobiliary Pancreat Surg. 2003;10:26–30.
    1. Nanashima A, Sumida Y, Morino S, et al. The Japanese integrated staging score using liver damage grade for hepatocellular carcinoma in patients after hepatectomy. Eur J Surg Oncol. 2004;30:765–770.
    1. Ikai I, Takayasu K, Omata M, et al. A modified Japan Integrated Stage score for prognostic assessment in patients with hepatocellular carcinoma. J Gastroenterol. 2006;41:884–892.
    1. Hayashi PH, Trotter JF, Forman L, et al. Impact of pretransplant diagnosis of hepatocellular carcinoma on cadveric liver allocation in the era of MELD. Liver Transpl. 2004;10:42–48.
    1. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: Comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria. Liver Transpl. 2002;8:765–774.
    1. Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment: Study of 850 patients. Cancer. 1985;56:918–928.
    1. Kulik LM. Can therapy of hepatitis C affect the development of hepatocellular carcinoma? J Natl Compr Canc Netw. 2006;4:751–757.
    1. Tokita H, Fukui H, Tanaka A, et al. Risk factors for the development of hepatocellular carcinoma among patients with chronic hepatitis C who achieved a sustained virological response to interferon therapy. J Gastroenterol Hepatol. 2005;20:752–758.
    1. Giannini EG, Bodini G, Corbo M, et al. Impact of evidence-based medicine on treatment of patients with unresectable hepatocellular carcinoma. Aliment Pharmacol Ther. 2010;31:493–501.
    1. Chang MH, You SL, Chen CJ, et al. Decreased incidence of hepatocellular carcinoma in hepatitis B vaccinees: A 20-year follow-up study. J Natl Cancer Inst. 2009;101:1348–1355.
    1. Beasley RP. Rocks along the road to the control of HBV and HCC. Ann Epidemiol. 2009;19:231–234.
    1. Omata M, Yoshida H. Prevention and treatment of hepatocellular carcinoma. Liver Transpl. 2004;10:S111–S114.
    1. Kane RC, Farrell AT, Madabushi R, et al. Sorafenib for the treatment of unresectable hepatocellular carcinoma. Oncologist. 2009;14:95–100.
    1. Lang L. FDA approves sorafenib for patients with inoperable liver cancer. Gastroenterology. 2008;134:379.
    1. García-Compean D, Jaquez-Quintana JO, Maldonado-Garza H. Hepatogenous diabetes: Current views of an ancient problem. Ann Hepatol. 2009;8:13–20.
    1. Zhong YD, Yang YF. Diabetes mellitus, chronic hepatitis C, and hepatocellular carcinoma. Hepatology. 2008;48:1348.
    1. Chuang SC, La Vecchia C, Boffetta P. Liver cancer: Descriptive epidemiology and risk factors other than HBV and HCV infection. Cancer Lett. 2009;286:9–14.
    1. Choi E Rogers E, Ahmad S, et al. Hepatobiliary cancers. In: Feig BW, Berger DH, Fuhrman GM, editors. The M. D. Anderson Surgical Oncology Handbook. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.
    1. Taura K, Ikai I, Hatano E, et al. Influence of coexisting cirrhosis on outcomes after partial hepatic resection for hepatocellular carcinoma fulfilling the Milan criteria: An analysis of 293 patients. Surgery. 2007;142:685–694.
    1. Cunningham SC, Tsai S, Marques HP, et al. Management of early hepatocellular carcinoma in patients with well-compensated cirrhosis. Ann Surg Oncol. 2009;16:1820–1831.
    1. Nuzzo G, Giuliante F, Gauzolino R, et al. Liver resections for hepatocellular carcinoma in chronic liver disease: Experience in an Italian centre. Eur J Surg Oncol. 2007;33:1014–1018.
    1. Llovet JM, Fuster J, Bruix J. Intention- to-treat analysis of surgical treatment for early hepatocellular carcinoma: Resection versus transplantation. Hepatology. 1999;30:1434–1440.
    1. Shah SA, Cleary SP, Tan JC, et al. An analysis of resection vs transplantation for early hepatocellular carcinoma: Defining the optimal therapy at a single institution. Ann Surg Oncol. 2007;14:2608–2614.
    1. Vauthey JN, Klimstra D, Franceschi D, et al. Factors affecting long-term outcome after hepatic resection for hepatocellular carcinoma. Am J Surg. 1995;169:28–34.
    1. Teh SH, Christein J, Donohue J, et al. Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: Model of End-Stage Liver Disease (MELD) score predicts perioperative mortality. J Gastrointest Surg. 2005;9:1207–1215.
    1. Pugh S, Lewis S, Rees Smith P. Bleeding oesophageal varices in alcoholic cirrhosis: Long-term follow-up of endoscopic sclerotherapy. Q J Med. 1993;86:241–245.
    1. Helling TS, Woodall CE., 3rd Referrals for surgical therapy in patients with hepatocellular carcinoma: A community experience. J Gastrointest Surg. 2007;11:76–81.
    1. Cucchetti A, Ercolani G, Vivarelli M, et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl. 2006;12:966–971.
    1. Poon RT, Fan ST, Lo CM, et al. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: Implications for a strategy of salvage transplantation. Ann Surg. 2002;235:373–382.
    1. Cha C, Fong Y, Jarnagin WR, et al. Predictors and patterns of recurrence after resection of hepatocellular carcinoma. J Am Coll Surg. 2003;197:753–758.
    1. Ringe B, Pichlmayr R, Wittekind C, et al. Surgical treatment of hepatocellular carcinoma: Experience with liver resection and transplantation in 198 patients. World J Surg. 1991;15:270–285.
    1. Bismuth H, Farges O, Castaing D, et al. Assessment of the results of liver transplantation and definition of criteria for the evaluation of transplant centers. Transplant Proc. 1997;29:456–458.
    1. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–699.
    1. Yao FY, Ferrell L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33:1394–1403.
    1. Yao FY, Bass NM, Nikolai B, et al. Liver transplantation for hepatocellular carcinoma: Analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl. 2002;8:873–883.
    1. Silva M, Moya A, Berenguer M, et al. Expanded criteria for liver transplantation in patients with cirrhosis and hepatocellular carcinoma. Liver Transpl. 2008;14:1449–1460.
    1. Takada Y, Ito T, Ueda M, et al. Living donor liver transplantation for patients with HCC exceeding the Milan criteria: A proposal of expanded criteria. Dig Dis. 2007;25:299–302.
    1. Lu X, Lee M, Tran T, et al. High level expression of apoptosis inhibitor in hepatoma cell line expressing Hepatitis B virus. Int J Med Sci. 2005;2:30–35.
    1. Heckman JT, Devera MB, Marsh JW, et al. Bridging locoregional therapy for hepatocellular carcinoma prior to liver transplantation. Ann Surg Oncol. 2008;15:3169–3177.
    1. Pompili M, Francica G, Rapaccini GL. Bridge treatments of hepatocellular carcinoma in cirrhotic patients submitted to liver transplantation. Dig Dis Sci. 2008;53:2830–2831.
    1. Belghiti J, Carr BI, Greig PD, et al. Treatment before liver transplantation for HCC. Ann Surg Oncol. 2008;15:993–1000.
    1. Zimmerman MA, Ghobrial RM, Tong MJ, et al. Recurrence of hepatocellular carcinoma following liver transplantation: A review of preoperative and postoperative prognostic indicators. Arch Surg. 2008;143:182–188.
    1. Lin SM, Lin CJ, Lin CC, et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut. 2005;54:1151–1156.
    1. Hong SN, Lee SY, Choi MS, et al. Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function. J Clin Gastroenterol. 2005;39:247–252.
    1. Livraghi T, Goldberg SN, Lazzaroni S, et al. Small hepatocellular carcinoma: Treatment with radio-frequency ablation versus ethanol injection. Radiology. 1999;210:655–661.
    1. Shirakami Y, Shimizu M, Adachi S, et al. (-)-Epigallocatechin gallate suppresses the growth of human hepatocellular carcinoma cells by inhibiting activation of the vascular endothelial growth factor-vascular endothelial growth factor receptor axis. Cancer Sci. 2009;100:1957–1962.
    1. Malagari K, Pomoni M, Kelekis A, et al. Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol. 2010;33:541–551.
    1. Bruix J, Sala M, Llovet JM. Chemoembolization for hepatocellular carcinoma. Gastroenterology. 2004;127:S179–S188.
    1. Brown DB, Pilgram TK, Darcy MD, et al. Hepatic arterial chemoembolization for hepatocellular carcinoma: Comparison of survival rates with different embolic agents. J Vasc Interv Radiol. 2005;16:1661–1666.
    1. Biselli M, Andreone P, Gramenzi A, et al. Transcatheter arterial chemoembolization therapy for patients with hepatocellular carcinoma: A case-controlled study. Clin Gastroenterol Hepatol. 2005;3:918–925.
    1. Lo CM, Ngan H, Tso WK, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35:1164–1171.
    1. Llovet JM, Real MI, Montaña X, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomised controlled trial. Lancet. 2002;359:1734–1739.
    1. A comparison of lipiodol chemoembolization and conservative treatment for unresectable hepatocellular carcinoma Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire. N Engl J Med. 1995;332:1256–1261.
    1. Pelletier G, Roche A, Ink O, et al. A randomized trial of hepatic arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol. 1990;11:181–184.
    1. Thornton RH, Covey A, Petre EN, et al. A comparison of outcomes from treating hepatocellular carcinoma by hepatic artery embolization in patients younger or older than 70 years. Cancer. 2009;115:5000–5006.
    1. Taieb J, Barbare JC, Boussaha T, et al. [Management of hepatocellular carcinoma. Where are we now? What's next?] Bull Cancer. 2009;96:19–34.
    1. Simonetti RG, Liberati A, Angiolini C, et al. Treatment of hepatocellular carcinoma: A systematic review of randomized controlled trials. Ann Oncol. 1997;8:117–136.
    1. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–390.
    1. Abou-Alfa GK, Venook AP. The impact of new data in the treatment of advanced hepatocellular carcinoma. Curr Oncol Rep. 2008;10:199–205.
    1. Chaparro M, González Moreno L, Trapero-Marugán M, et al. Review article: Pharmacological therapy for hepatocellular carcinoma with sorafenib and other oral agents. Aliment Pharmacol Ther. 2008;28:1269–1277.
    1. Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: A phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34.
    1. Nannini M, Pantaleo MA, Maleddu A, et al. Gene expression profiling in colorectal cancer using microarray technologies: Results and perspectives. Cancer Treat Rev. 2009;35:201–209.
    1. Weigelt K, Lichtinger M, Rehli M, et al. Transcriptomic profiling identifies a PU.1 regulatory network in macrophages. Biochem Biophys Res Commun. 2009;380:308–312.
    1. Jonas S, Al-Abadi H, Benckert C, et al. Prognostic significance of the DNA-index in liver transplantation for hepatocellular carcinoma in cirrhosis. Ann Surg. 2009;250:1008–1013.
    1. Realdi G, Fattovich G, Hadziyannis S, et al. Survival and prognostic factors in 366 patients with compensated cirrhosis type B: A multicenter study—The Investigators of the European Concerted Action on Viral Hepatitis (EUROHEP) J Hepatol. 1994;21:656–666.
    1. Ren N, Ye QH, Qin LX, et al. Circulating DNA level is negatively associated with the long-term survival of hepatocellular carcinoma patients. World J Gastroenterol. 2006;12:3911–3914.
    1. Wang W, Peng JX, Yang JQ, et al. Identification of gene expression profiling in hepatocellular carcinoma using cDNA microarrays. Dig Dis Sci. epub ahead of print on January 1, 2009.
    1. Thorgeirsson SS, Lee JS, Grisham JW. Functional genomics of hepatocellular carcinoma. Hepatology. 2006;43:S145–S150.
    1. Inoue T, Kudo M, Hatanaka K, et al. Imaging of hepatocellular carcinoma: Qualitative and quantitative analysis of postvascular phase contrast-enhanced ultrasonography with sonazoid—Comparison with superparamagnetic iron oxide magnetic resonance images. Oncology. 2008;75(suppl 1):48–54.
    1. Zhu AX, Sahani DV, Duda DG, et al. Efficacy, safety, and potential biomarkers of sunitinib monotherapy in advanced hepatocellular carcinoma: A phase II study. J Clin Oncol. 2009;27:3027–3035.
    1. Woodall CE, Scoggins CR, Loehle J, et al. Hepatic imaging characteristics predict overall survival in hepatocellular carcinoma. Ann Surg Oncol. 2007;14:2824–2830.
    1. Ho CL, Chen S, Yeung DW, et al. Dual-tracer PET/CT imaging in evaluation of metastatic hepatocellular carcinoma. J Nucl Med. 2007;48:902–909.
    1. Song I, Rhim H, Lim HK, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: Safety and technical efficacy in 143 patients. Eur Radiol. 2009;19:2630–2640.
    1. Zhu AX, Raymond E. Early development of sunitinib in hepatocellular carcinoma. Expert Rev Anticancer Ther. 2009;9:143–150.
    1. Faivre S, Raymond E, Boucher E, et al. Safety and efficacy of sunitinib in patients with advanced hepatocellular carcinoma: An open-label, multicentre, phase II study. Lancet Oncol. 2009;10:794–800.
    1. Finn RS, Kang Y, Park J, et al. Phase II, open label study of brivanib alaninate in patients (pts) with hepatocellular carcinoma (HCC) who failed prior antiangiogenic therapy. American Society of Clinical Oncology 2009 Gastrointestinal Cancers Symposium; January 15–17, 2009; San Francisco, CA.
    1. Thomas MB, Morris JS, Chadha R, et al. Phase II trial of the combination of bevacizumab and erlotinib in patients who have advanced hepatocellular carcinoma. J Clin Oncol. 2009;27:843–850.
    1. Huynh H, Ngo VC, Koong HN, et al. AZD6244 enhances the anti-tumor activity of sorafenib in ectopic and orthotopic models of human hepatocellular carcinoma (HCC) J Hepatol. 2010;52:79–87.
    1. Ito Y, Sasaki Y, Horimoto M, et al. Activation of mitogen-activated protein kinases/extracellular signal-regulated kinases in human hepatocellular carcinoma. Hepatology. 1998;27:951–958.
    1. McKillop IH, Schmidt CM, Cahill PA, et al. Altered expression of mitogen-activated protein kinases in a rat model of experimental hepatocellular carcinoma. Hepatology. 1997;26:1484–1491.
    1. Yau T, Chan P, Epstein R, et al. Management of advanced hepatocellular carcinoma in the era of targeted therapy. Liver Int. 2009;29:10–17.
    1. Zhou Q, He Q, Liang LJ. Expression of p27, cyclin E and cyclin A in hepatocellular carcinoma and its clinical significance. World J Gastroenterol. 2003;9:2450–2454.
    1. Zhou H, Cheng B, Lin J. Expression of DNA repair enzyme hMTH1 mRNA and protein in hepatocellular carcinoma. J Huazhong Univ Sci Technolog Med Sci. 2005;25:389–392.
    1. Treiber G. mTOR inhibitors for hepatocellular cancer: A forward-moving target. Expert Rev Anticancer Ther. 2009;9:247–261.
    1. Sahin M, Allard BL, Yates M, et al. PPARgamma staining as a surrogate for PAX8/PPARgamma fusion oncogene expression in follicular neoplasms: Clinicopathological correlation and histopathological diagnostic value. J Clin Endocrinol Metab. 2005;90:463–468.
    1. Villanueva A, Chiang DY, Newell P, et al. Pivotal role of mTOR signaling in hepatocellular carcinoma. Gastroenterology. 2008;135:1972–1983.
    1. Fausto N. Growth factors in liver development, regeneration and carcinogenesis. Prog Growth Factor Res. 1991;3:219–234.
    1. Hisaka T, Yano H, Haramaki M, et al. Expressions of epidermal growth factor family and its receptor in hepatocellular carcinoma cell lines: Relationship to cell proliferation. Int J Oncol. 1999;14:453–460.
    1. Zhu AX. Development of sorafenib and other molecularly targeted agents in hepatocellular carcinoma. Cancer. 2008;112:250–259.
    1. Thomas MB, Chadha R, Glover K, et al. Phase 2 study of erlotinib in patients with unresectable hepatocellular carcinoma. Cancer. 2007;110:1059–1067.
    1. Philip PA, Mahoney MR, Allmer C, et al. Phase II study of Erlotinib (OSI-774) in patients with advanced hepatocellular cancer. J Clin Oncol. 2005;23:6657–6663.
    1. Kanda M, Nomoto S, Nishikawa Y, et al. Correlations of the expression of vascular endothelial growth factor B and its isoforms in hepatocellular carcinoma with clinico-pathological parameters. J Surg Oncol. 2008;98:190–196.
    1. Shim JH, Park JW, Kim JH, et al. Association between increment of serum VEGF level and prognosis after transcatheter arterial chemoembolization in hepatocellular carcinoma patients. Cancer Sci. 2008;99:2037–2044.
    1. Hu J, Xu Y, Shen ZZ, et al. High expressions of vascular endothelial growth factor and platelet-derived endothelial cell growth factor predict poor prognosis in alpha-fetoprotein-negative hepatocellular carcinoma patients after curative resection. J Cancer Res Clin Oncol. 2009;135:1359–1367.
    1. Finn RS, Zhu AX. Targeting angiogenesis in hepatocellular carcinoma: Focus on VEGF and bevacizumab. Expert Rev Anticancer Ther. 2009;9:503–509.
    1. Azad NS, Posadas EM, Kwitkowski VE, et al. Combination targeted therapy with sorafenib and bevacizumab results in enhanced toxicity and antitumor activity. J Clin Oncol. 2008;26:3709–3714.
    1. Abou-Alfa GK, Schwartz L, Ricci S, et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol. 2006;24:4293–4300.
    1. Siegel AB, Cohen EI, Ocean A, et al. Phase II trial evaluating the clinical and biologic effects of bevacizumab in unresectable hepatocellular carcinoma. J Clin Oncol. 2008;26:2992–2998.
    1. Huynh H, Chow PK, Palanisamy N, et al. Bevacizumab and rapamycin induce growth suppression in mouse models of hepatocellular carcinoma. J Hepatol. 2008;49:52–60.
    1. Ma WW, Hidalgo M. Exploiting novel molecular targets in gastrointestinal cancers. World J Gastroenterol. 2007;13:5845–5856.
    1. Höpfner M, Schuppan D, Scherübl H. Growth factor receptors and related signalling pathways as targets for novel treatment strategies of hepatocellular cancer. World J Gastroenterol. 2008;14:1–14.
    1. Marelli L, Stigliano R, Triantos C, et al. Transarterial therapy for hepatocellular carcinoma: Which technique is more effective? A systematic review of cohort and randomized studies. Cardiovasc Intervent Radiol. 2007;30:6–25.
    1. Schoenleber SJ, Kurtz DM, Talwalkar JA, et al. Prognostic role of vascular endothelial growth factor in hepatocellular carcinoma: Systematic review and meta-analysis. Br J Cancer. 2009;100:1385–1392.
    1. Pleguezuelo M, Marelli L, Misseri M, et al. TACE versus TAE as therapy for hepatocellular carcinoma. Expert Rev Anticancer Ther. 2008;8:1623–1641.

Source: PubMed

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