Traitements du carcinome hépatocellulaire non accessible à un traitement curatif: Actualités

Palliative treatments play a major role in the management of hepatocellular carcinoma (HCC), as only a third of the patients are eligible for a curative treatment, and 70% of them have tumor recurrence after five years. Promising new loco-regional therapies including transarterial chemoembolization (TACE) with drug-eluting beads and yttrium-90 microsphere radioembolization are currently under investigation. Their superiority in terms of clinical benefit over classical TACE remains to be established. No systemic cytotoxic drug or combination has been shown to convincingly improve survival over supportive care. Randomized trials are needed to address endpoints of survival and clinical benefit in a well-characterized and selected patient population, namely those without underlying cirrhosis and potentially resectable tumors after downstaging. Sorafenib has shown survival benefits and has been recently approved as the first standard systemic palliative treatment for patients with advanced HCC. The efficacy of targeted therapies for liver cancer has triggered the search for additional molecular agents including other antiangiogenic therapies and mTOR inhibitors, which are currently under investigation. Identification of predictive candidate biomarkers selected according to the molecular pathways associated with HCC subclasses and to the drug target remains a major challenge to select patients who may benefit from molecular targeted therapies.