From the Guidelines
Malignancies of the liver should be managed with a focus on early detection and treatment, as the prognosis is highly dependent on the cancer stage and underlying liver function, with liver transplantation being a potential cure for hepatocellular carcinoma (HCC) in selected patients 1. The primary liver cancers include hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma, with HCC being the most common type. HCC typically arises in patients with chronic liver disease, such as cirrhosis from hepatitis B, hepatitis C, alcoholic liver disease, or non-alcoholic steatohepatitis.
- Diagnosis involves imaging studies (ultrasound, CT, MRI), serum alpha-fetoprotein levels, and often liver biopsy.
- Treatment options depend on cancer stage, liver function, and patient performance status, with early-stage HCC being treated with surgical resection, liver transplantation, or ablative therapies like radiofrequency ablation.
- Intermediate-stage disease often receives transarterial chemoembolization (TACE), while advanced HCC may be treated with systemic therapies, including sorafenib, lenvatinib, or immunotherapy combinations like atezolizumab plus bevacizumab, which has become the first-line systemic treatment in Asian countries for patients ineligible for radical treatment or transarterial chemoembolization 1. The most recent guidelines suggest that atezolizumab+bevacizumab therapy should be considered as the first-line systemic treatment for advanced HCC, given its improved outcomes compared to traditional therapies 1. Regular surveillance with ultrasound and AFP every 6 months is recommended for high-risk patients with cirrhosis to detect HCC early when curative options are still possible. Prognosis varies widely based on cancer stage, underlying liver function, and treatment response, with Taiwan and Japan having the best clinical outcomes for patients with HCC worldwide 1.
From the FDA Drug Label
Hepatocellular Carcinoma (HCC) For the first-line treatment of patients with unresectable hepatocellular carcinoma (HCC). LENVIMA is a kinase inhibitor that is indicated: HCC: The recommended dosage is based on actual body weight: 12 mg orally once daily for patients greater than or equal to 60 kg or 8 mg orally once daily for patients less than 60 kg.
Malignancies of the liver are addressed in the context of Hepatocellular Carcinoma (HCC) treatment. The drug label for lenvatinib (PO) indicates that it is used for the first-line treatment of patients with unresectable hepatocellular carcinoma (HCC). The recommended dosage is based on the patient's actual body weight.
- Key points:
- Indication: First-line treatment for unresectable HCC
- Dosage: 12 mg orally once daily for patients ≥ 60 kg or 8 mg orally once daily for patients < 60 kg
- Reference: 2
From the Research
Malignancies of the Liver: Treatment Options
- Hepatocellular carcinoma (HCC) is one of the most common solid cancers in the world, with various treatment strategies available, including surgical resection and liver transplantation 3, 4.
- The choice between surgical resection and liver transplantation depends on several factors, including the stage of the cancer, the functional status of the liver parenchyma, and the presence of cirrhosis and portal hypertension 3, 5.
Surgical Resection vs. Liver Transplantation
- Surgical resection can be curative in patients with early-stage HCC and well-preserved hepatic synthetic function, while liver transplantation offers the best long-term survival and lowest incidence of tumor recurrence in select patients with HCC and underlying cirrhosis 4, 5.
- However, there are no randomized clinical trials comparing surgical resection and liver transplantation for HCC treatment, making it difficult to determine the best treatment option for individual patients 6.
Treatment Outcomes for Patients with HCC Beyond Milan Criteria
- Liver resection and transplantation can provide curative options for patients with HCC beyond Milan criteria, with overall and disease-free survival rates varying depending on the treatment approach and patient characteristics 7.
- Tumor downstaging and transplantation can improve outcomes in patients with large or multifocal HCC, highlighting the need for further treatment strategies aimed at expanding the role of transplantation among suitable candidates 7.