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Hamzah N, Kassim NK, Omar J, Abdullah MS, Lee YY. Levels of PIVKA-II and alpha-fetoprotein in unresectable hepatocellular carcinoma compared to healthy controls and predictive values of both markers with radiological responses after loco-regional interventions. PeerJ 2023; 11:e15988. [PMID: 37780370 PMCID: PMC10538296 DOI: 10.7717/peerj.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/08/2023] [Indexed: 10/03/2023] Open
Abstract
Background The significance of the current study was to determine normative levels of PIVKA-II and AFP in patients with unresectable HCC and healthy participants. The second goal was to assess the roles of PIVKA-II and AFP in predicting radiological response after loco-regional therapy. Methods This prospective cohort study enrolled consecutive samples of HCC patients and healthy controls. Venous blood samples were obtained at baseline and after interventions to determine serum levels of PIVKA-II and AFP using the chemiluminescent microparticle immunoassay method. Radiologic responses were determined based on the WHO criteria. Results Fifty-four HCC patients (mean age 58.9 years, 49 males) and 40 healthy controls (mean age 33.5 years, 26 males) were recruited. The median serum levels of PIVKA-II and AFP in HCC vs. healthy controls were 988.4 vs. 24.2 mAU/ml and 13.6 vs. 1.7 ng/ml, respectively (both p < 0.001). With ROC curve analysis, the area under the curve (AUC) for PIVKA-II was 0.95 95% CI [0.90-0.99], and for AFP it was 0.98, 95% CI [0.95-1.0]). The cut-off value for PIVKA-II was 41.4 mAU/ml, and AFP was 4.8 ng/ml. PIVKA-II levels correlated significantly with radiological responses (r = 0.64, p = 0.02) but not AFP (r = 0.09, p = 0.2). Conclusion PIVKA-II and AFP levels are distinctive between unresectable HCC and healthy controls. However, PIVKA-II, not AFP, can predict the radiological response after loco-regional therapy.
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Affiliation(s)
- Norhanan Hamzah
- Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nur Karyatee Kassim
- Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Julia Omar
- Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Mohd Shafie Abdullah
- Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Yeong Yeh Lee
- Hospital Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- Department of Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Hsu PY, Liang PC, Chang WT, Lu MY, Wang WH, Chuang SC, Wei YJ, Jang TY, Yeh ML, Huang CI, Lin YH, Wang CW, Hsieh MY, Hou NJ, Hsieh MH, Tsai YS, Ko YM, Lin CC, Chen KY, Dai CY, Lin ZY, Chen SC, Chuang WL, Huang CF, Huang JF, Yu ML. Artificial intelligence based on serum biomarkers predicts the efficacy of lenvatinib for unresectable hepatocellular carcinoma. Am J Cancer Res 2022; 12:5576-5588. [PMID: 36628276 PMCID: PMC9827079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/12/2022] [Indexed: 01/12/2023] Open
Abstract
Lenvatinib has been effective not only as a first-line but also as a later-line systemic therapy for unresectable hepatocellular carcinoma (uHCC) in real-world clinical practice. How to predict the efficacy of lenvatinib and guide appropriate therapy selection in patients with uHCC have become important issues. This study aimed to investigate the impact of serum biomarkers on the treatment outcomes of patients with uHCC treated with lenvatinib in a real-world setting using an artificial intelligence algorithm. We measured serum biomarkers, including alpha-fetoprotein (AFP), albumin-bilirubin (ALBI) grade, and circulating angiogenic factors (CAFs [i.e., vascular endothelial growth factor, angiopoietin-2, fibroblast growth factor-19 [FGF19], and FGF21]) and analyzed treatment outcomes, including objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) in patients with uHCC treated with lenvatinib. The results of this study demonstrated that an AFP reduction ≥ 40% from baseline within 8 weeks after lenvatinib induction was associated with a higher ORR. With baseline biomarkers using a decision tree-based model, we identified patients with high, intermediate, and low ORRs (84.6%, 21.7% and 0%, respectively; odds ratio, 53.04, P < 0.001, high versus intermediate/low groups). Based on the decision tree-based survival predictive model, baseline AFP was the most important factor for OS, followed by ALBI grade and FGF21.
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Affiliation(s)
- Po-Yao Hsu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Po-Cheng Liang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Wen-Tsan Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Ming-Ying Lu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen UniversityKaohsiung, Taiwan
| | - Wen-Hsuan Wang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Shih-Chang Chuang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Yu-Ju Wei
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Tyng-Yuan Jang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Ching-I Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Yi-Hung Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Chih-Wen Wang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Ming-Yen Hsieh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Nai-Jen Hou
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Meng-Hsuan Hsieh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen UniversityKaohsiung, Taiwan
| | - Yi-Shan Tsai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Yu-Min Ko
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Ching-Chih Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Kuan-Yu Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen UniversityKaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research and Center for Cancer Research, Kaohsiung Medical UniversityKaohsiung, Taiwan
- School of Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen UniversityKaohsiung, Taiwan
- National Pingtung University of Science and TechnologyPingtung, Taiwan
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Combination Intensity-Modulated Radiotherapy and Sorafenib Improves Outcomes in Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis. JOURNAL OF ONCOLOGY 2021; 2021:9943683. [PMID: 34899910 PMCID: PMC8664501 DOI: 10.1155/2021/9943683] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/05/2021] [Indexed: 12/29/2022]
Abstract
Purpose To compare the difference in outcome of hepatocellular carcinoma (HCC) with portal vein thrombosis (PVTT) between intensity-modulated radiotherapy (IMRT) concurrent with sorafenib and IMRT alone. Methods A total of 82 patients with PVTT from 2014 to 2019 were included. Of these, 36 received IMRT concurrent with sorafenib treatment (group A), while 46 underwent IMRT alone (group B). The dose of IMRT was 40.0–62.5 Gy/2–2.5 Gy/4–6 w, and patients received orally administered sorafenib 400 mg twice a day in combination with IMRT. Overall survival (OS), progression-free survival (PFS), and median distant metastasis-free survival (DMFS) were evaluated by using LIFETEST procedure of SAS. Results The median survival time was 11.0 months in group A versus 9.0 months in group B. The 1- and 2-year OS in group A were 44.9% and 3.8% versus 28.6% and 2.6% in group B (P=0.036), respectively. The median PFS was 6.0 months in group A versus 3.0 months in group B. The 1- and 2-year PFS in group A were 20.7% and 6.9% versus 2.7% and 0.0% in group B (P=0.012), respectively. The 1- and 2-year DMFS in group A were 38.0% and 7.9% versus 16.7% and 0.0% in group B (P=0.019), respectively. Multivariate analysis showed that Child–Pugh classification, AFP response, and overall response were independent risk factors for OS (P < 0.05). There were no significant differences in adverse events except fatigue and skin reactions between the two groups. Conclusion Compared with IMRT alone, IMRT concurrent with sorafenib can improve the long-term efficacy of HCC patients with PVTT, without increasing adverse reactions. The patients with Child–Pugh A, overall response, and AFP response obtained better OS.
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Ando Y, Kawaoka T, Kosaka M, Shirane Y, Johira Y, Miura R, Murakami S, Yano S, Amioka K, Naruto K, Kosaka Y, Uchikawa S, Kodama K, Fujino H, Nakahara T, Ono A, Murakami E, Yamauchi M, Okamoto W, Takahashi S, Imamura M, Chayama K, Aikata H. Early Tumor Response and Safety of Atezolizumab Plus Bevacizumab for Patients with Unresectable Hepatocellular Carcinoma in Real-World Practice. Cancers (Basel) 2021; 13:3958. [PMID: 34439111 PMCID: PMC8394131 DOI: 10.3390/cancers13163958] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to investigate the early tumor response and safety of atezolizumab plus bevacizumab for patients with unresectable hepatocellular carcinoma in real-world practice. Forty patients with Child-Pugh class A liver function and eastern cooperative oncology group performance status 0 or 1 were enrolled. The objective response rate (ORR) at six weeks after the start of treatment, changes in α-fetoprotein (AFP) and des-γ-carboxyprothrombin, incidence of adverse events (AEs), and changes in albumin-bilirubin (ALBI) score and serum ammonia level, were evaluated. Among 40 patients, 24 had histories of prior molecular targeted agents (MTAs). The ORR was 22.5% based on mRECIST. Multivariate analysis showed that an AFP ratio <1.0 at three weeks (odds ratio 39.2, 95% confidence interval CI 2.37-649.0, p = 0.0103) was the only significant factor for predicting early response. There was no significant difference in the frequency of AEs between patients receiving first-line treatments and others. Fatigue, proteinuria, and ascites were more frequent in patients who experienced prior treatment. No decrease in ALBI score or increase in serum ammonia level was observed. Our study demonstrated that AFP may be useful in assessing early response and that this treatment is safe, including in patients with prior MTA treatments.
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Affiliation(s)
- Yuwa Ando
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Tomokazu Kawaoka
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Masanari Kosaka
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Yuki Shirane
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Yusuke Johira
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Ryoichi Miura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Serami Murakami
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Shigeki Yano
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Kei Amioka
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Kensuke Naruto
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Yumi Kosaka
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Shinsuke Uchikawa
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Kenichiro Kodama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Hatsue Fujino
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Takashi Nakahara
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Atsushi Ono
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Eisuke Murakami
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Masami Yamauchi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
- Department of Clinical Oncology, Hiroshima University Hospital, Hiroshima 734-8551, Japan;
| | - Wataru Okamoto
- Department of Clinical Oncology, Hiroshima University Hospital, Hiroshima 734-8551, Japan;
| | - Shoichi Takahashi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Michio Imamura
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
| | - Kazuaki Chayama
- Collaborative Research Laboratory of Medical Innovation, Hiroshima University, Hiroshima 734-8551, Japan;
- Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima 734-8551, Japan
- RIKEN Center for Integrative Medical Sciences, Yokohama 230-0045, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (Y.A.); (T.K.); (M.K.); (Y.S.); (Y.J.); (R.M.); (S.M.); (S.Y.); (K.A.); (K.N.); (Y.K.); (S.U.); (K.K.); (H.F.); (T.N.); (A.O.); (E.M.); (M.Y.); (S.T.); (M.I.)
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Kegasawa T, Sakamori R, Maesaka K, Yamada R, Tahata Y, Urabe A, Kodama T, Hikita H, Imanaka K, Ohkawa K, Hiramatsu N, Oshita M, Yamada Y, Inada M, Yakushijin T, Imai Y, Tatsumi T, Takehara T. Lower Serum Sodium Levels Are Associated with the Therapeutic Effect of Sorafenib on Hepatocellular Carcinoma. Dig Dis Sci 2021; 66:1720-1729. [PMID: 32556820 DOI: 10.1007/s10620-020-06380-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/30/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Although the serum sodium level has been reported to be a prognostic and predictive marker for the therapeutic effects of lung cancer and renal cell carcinoma treated with molecular targeted therapy, the serum sodium level has not been investigated in hepatocellular carcinoma (HCC) patients treated with sorafenib. The aim of our analysis was to assess the prognostic role of serum sodium levels in these patients. METHODS We retrospectively analyzed 341 HCC patients treated with sorafenib between 2009 and 2012 in our hospital and other related institutions. RESULTS A total of 178 patients were enrolled in this study. The median age was 72 years (44-88), and 148 patients (83%) were male. The median overall survival (OS) was 12.9 months, and the median time to progression (TTP) was 3.1 months. Hyponatremia (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.26-2.52), a lower sodium level (HR 1.57, 95% CI 1.07-2.80), and a high level of α-fetoprotein (AFP) (≥ 200 ng/mL) (HR 1.78, 95% CI 1.26-2.52) were independent prognostic factors for TTP. We also categorized the patients into three groups according to serum sodium and AFP levels: Group A (n = 39) (serum sodium > 140 mEq/L, AFP < 200 ng/mL), Group C (n = 58) (serum sodium ≤ 140 mEq/L, AFP ≥ 200 ng/mL), and Group B (n = 81) (other patients). Significantly longer TTP and OS were observed in the following order: Groups A, C, and B. CONCLUSION Serum sodium levels are associated with the effectiveness of sorafenib. The serum sodium level can predict the therapeutic effect of sorafenib in advanced HCC patients.
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Affiliation(s)
- Tadashi Kegasawa
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryotaro Sakamori
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuki Maesaka
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryoko Yamada
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuki Tahata
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ayako Urabe
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takahiro Kodama
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hayato Hikita
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | | | | | | | | | - Masami Inada
- Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | | | | | - Tomohide Tatsumi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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6
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Komisarof J, Qiu H, Velez MJ, Mulford D. Anterior mediastinal large cell neuroendocrine carcinoma with elevated AFP: A case report and review. Mol Clin Oncol 2020; 14:34. [PMID: 33414915 PMCID: PMC7783711 DOI: 10.3892/mco.2020.2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/18/2020] [Indexed: 11/05/2022] Open
Abstract
Large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive cancer that typically presents in the lung. The current case report describes a 56 year old male who presented to Strong Memorial Hospital with progressive dyspnea and was revealed to have a large anterior mediastinal tumor with metastases to axillary, hilar and mediastinal lymph nodes. Tumor marker results revealed an elevated plasma level of α-fetoprotein (AFP), which initially pointed towards a diagnosis of teratoma, but the tumor stained positive for neuroendocrine markers CD56, chromogranin, and synaptophysin on biopsy, consistent with LCNEC. AFP-positive tumor cells were identified, and no alternate cause for the elevated AFP was identified. The patient underwent genetic testing revealing the tumor to be ALK, ROS1, KRAS, BRAF and EGFR wild type. The patient received 6 cycles of chemotherapy with cisplatin (80 mg/m2) and etoposide (100 mg/m2) and then radiation with an initial minor response. The patients course was complicated by the development of superior vena cava syndrome requiring emergency stenting. The results of the current case suggest that AFP may be worthy of further exploration as a potential tumor marker in LCNEC.
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Affiliation(s)
- Justin Komisarof
- Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Haoming Qiu
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Moises J Velez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Deborah Mulford
- Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
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7
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Gomez-Puerto D, Mirallas O, Vidal-González J, Vargas V. Hepatocellular carcinoma with tumor thrombus extends to the right atrium and portal vein: A case report. World J Hepatol 2020; 12:1128-1135. [PMID: 33312435 PMCID: PMC7701967 DOI: 10.4254/wjh.v12.i11.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/23/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most important primary malignant liver disease. A large proportion of patients with advanced HCC have macrovascular invasion. HCC tends to infiltrate vascular structures, particularly the portal vein and its branches, and more rarely, the hepatic veins. The intravascular tumor thrombus can affect the inferior vena cava (IVC) or even the right atrium (RA), the latter having a poor prognosis.
CASE SUMMARY HCC is one of the most aggressive malignant tumors. Tumor thrombus (TT) formation in advanced HCC stages is common and usually involves the hepatic or portal veins. Herein, we report a 69-year-old woman who presented with dyspnea to the emergency department. A ventilation/perfusion lung scan was performed, ruling out pulmonary embolism. Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography, but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging. Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA. HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.
CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis. There is no consensus about anticoagulation or other interventions in these patients.
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Affiliation(s)
- Diego Gomez-Puerto
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | - Oriol Mirallas
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | | | - Victor Vargas
- Liver Unit, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, Spain
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8
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Kelley RK, Meyer T, Rimassa L, Merle P, Park JW, Yau T, Chan SL, Blanc JF, Tam VC, Tran A, Dadduzio V, Markby DW, Kaldate R, Cheng AL, El-Khoueiry AB, Abou-Alfa GK. Serum Alpha-fetoprotein Levels and Clinical Outcomes in the Phase III CELESTIAL Study of Cabozantinib versus Placebo in Patients with Advanced Hepatocellular Carcinoma. Clin Cancer Res 2020; 26:4795-4804. [PMID: 32636319 PMCID: PMC7779341 DOI: 10.1158/1078-0432.ccr-19-3884] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/05/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The phase III CELESTIAL study demonstrated improved overall survival (OS) and progression-free survival (PFS) with cabozantinib versus placebo in patients with previously treated, advanced hepatocellular carcinoma (HCC). We analyzed outcomes by baseline alpha-fetoprotein (AFP) and on-treatment AFP changes. PATIENTS AND METHODS Serum AFP was measured every 8 weeks by blinded, centralized testing. Outcomes were analyzed by baseline AFP bifurcated at 400 ng/mL and by on-treatment AFP response (≥20% decrease from baseline at Week 8). The optimal cutoff for change in AFP at Week 8 was evaluated using maximally selected rank statistics. RESULTS Median OS for cabozantinib versus placebo was 13.9 versus 10.3 months [HR, 0.81; 95% confidence interval (CI), 0.62-1.04] for patients with baseline AFP <400 ng/mL, and 8.5 versus 5.2 months (HR, 0.71; 95% CI, 0.54-0.94) for patients with baseline AFP ≥400 ng/mL. Week 8 AFP response rate was 50% for cabozantinib versus 13% for placebo. In the cabozantinib arm, median OS for patients with and without AFP response was 16.1 versus 9.1 months (HR, 0.61; 95% CI, 0.45-0.84). AFP response was independently associated with longer OS. The optimal cutoff for association with OS in the cabozantinib arm was ≤0% change in AFP at Week 8 [AFP control; HR 0.50 (95% CI, 0.35-0.71)]. HRs for PFS were consistent with those for OS. CONCLUSIONS Cabozantinib improved outcomes versus placebo across a range of baseline AFP levels. On-treatment AFP response and control rates were higher with cabozantinib than placebo, and were associated with longer OS and PFS with cabozantinib.
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Affiliation(s)
- Robin Kate Kelley
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California.
| | - Tim Meyer
- Royal Free Hospital and UCL Cancer Institute, London, United Kingdom
| | - Lorenza Rimassa
- Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | | | | | - Stephen L Chan
- The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | | | - Vincent C Tam
- Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | | | - Vincenzo Dadduzio
- Medical Oncology Unit 1, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | | | | | - Ann-Lii Cheng
- National Taiwan University Cancer Center, Taipei, Taiwan
| | | | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Medical College at Cornell University, New York, New York
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9
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Tsai MC, Yen YH, Chang KC, Hung CH, Chen CH, Lin MT, Hu TH. Elevated levels of serum urokinase plasminogen activator predict poor prognosis in hepatocellular carcinoma after resection. BMC Cancer 2019; 19:1169. [PMID: 31791275 PMCID: PMC6889356 DOI: 10.1186/s12885-019-6397-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/22/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Urokinase plasminogen activator (uPA) is an extracellular matrix-degrading protease that is involved in the invasiveness and progression of cancer. There is good evidence that uPA expression is a clinically relevant biomarker in some solid tumors, but its role in hepatocellulcar carcinoma (HCC) is uncertain. We evaluated the prognostic value of serum uPA before surgery in HCC patients receiving curative resection. METHODS Serum uPA levels were determined by enzyme-linked immunosorbent assay in 282 HCC patients who received complete liver resections at Kaohsiung Chang Gung Memorial Hospital. Overall survival (OS) curves were constructed using the Kaplan-Meier method and compared using the log-rank test. A Cox proportional -hazards regression model was used to identify independent prognostic factors. The median follow-up time was 52 months. RESULTS Patients with higher pretreatment serum uPA (≥1 ng/ml) had significantly shorter OS (p = 0.002). Patients with liver cirrhosis, hypoalbuminemia, and thrombocytopenia were significantly more likely to present with elevated uPA levels. Multivariate Cox regression analyses indicated that high pretreatment serum uPA [hazard ratio (HR), 1.848, p = 0.006], vascular invasion (HR, 2.940, p < 0.001), and pathology stage III/IV (HR, 3.517, p < 0.001) were independent prognostic factors for OS. In further stratified analyses, the combination of serum uPA and AFP had more capacity to predict OS. CONCLUSIONS We conclude that uPA is a clinically relevant biomarker in HCC patients receiving curative resection, with higher expression of uPA being associated with higher mortality. This also highlights the potential utility of uPA as a therapeutic target for improved treatment strategies.
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Affiliation(s)
- Ming-Chao Tsai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Dist., Kaohsiung City, 83301, Taiwan.,Institute of Clinical Medical Sciences, Chang Gung University, Kaohsiung, 83301, Taiwan
| | - Yi-Hao Yen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Dist., Kaohsiung City, 83301, Taiwan
| | - Kuo-Chin Chang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Dist., Kaohsiung City, 83301, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Dist., Kaohsiung City, 83301, Taiwan.,Division of Hepato-Gastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, 61363, Taiwan
| | - Chien-Hung Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Dist., Kaohsiung City, 83301, Taiwan
| | - Ming-Tsung Lin
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Dist., Kaohsiung City, 83301, Taiwan
| | - Tsung-Hui Hu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung Dist., Kaohsiung City, 83301, Taiwan.
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10
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Brunetti O, Gnoni A, Licchetta A, Longo V, Calabrese A, Argentiero A, Delcuratolo S, Solimando AG, Casadei-Gardini A, Silvestris N. Predictive and Prognostic Factors in HCC Patients Treated with Sorafenib. ACTA ACUST UNITED AC 2019; 55:medicina55100707. [PMID: 31640191 PMCID: PMC6843290 DOI: 10.3390/medicina55100707] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/13/2022]
Abstract
Sorafenib is an oral kinase inhibitor that enhances survival in patients affected by advanced hepatocellular carcinoma (HCC). According to the results of two registrative trials, this drug represents a gold quality standard in the first line treatment of advanced HCC. Recently, lenvatinib showed similar results in terms of survival in a non-inferiority randomized trial study considering the same subset of patients. Unlike other targeted therapies, predictive and prognostic markers in HCC patients treated with sorafenib are lacking. Their identification could help clinicians in the daily management of these patients, mostly in light of the new therapeutic options available in the first.
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Affiliation(s)
- Oronzo Brunetti
- Medical Oncology Unit, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy.
| | - Antonio Gnoni
- Medical Oncology Unit, "S. Cuore di Gesù" Hospital, 73014 Gallipoli, Italy.
| | | | - Vito Longo
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy.
| | - Angela Calabrese
- Radiology Unit, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy.
| | - Antonella Argentiero
- Medical Oncology Unit, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy.
| | - Sabina Delcuratolo
- Scientific Direction, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy.
| | - Antonio Giovanni Solimando
- Medical Oncology Unit, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy.
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "G. Baccelli", University of Bari Medical School, 70124 Bari, Italy.
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, IstitutoScientifico Romagnolo per Lo Studio e Cura Dei Tumori (IRST) IRCCS, 47014 Meldola, Italy.
- Department of Oncology and Haematology, University Hospital of Modena, 41125 Modena, Italy.
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Research Centre, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy.
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
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11
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Nenu I, Breaban I, Pascalau S, Bora CN, Stefanescu H. The future is now: beyond first line systemic therapy in hepatocellular carcinoma. Transl Cancer Res 2019; 8:S261-S274. [PMID: 35117106 PMCID: PMC8797356 DOI: 10.21037/tcr.2018.11.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) is becoming a worldwide concern due to its rising incidence. Although for the incipient stages there are curative therapies, the advanced disease represents a major provocation for the clinicians. 2008 marked as an important year for the hepatology community with the administration of sorafenib for late stages of HCC. Six years after this major discovery, the multikinase inhibitor still represents an important pillar, the first line treatment for the advanced liver cancer. Lenvatinib may represent a new promising first line strategy, but it is still unavailable in many countries. The last years represented an explosion in the research of HCC. Beyond the first line treatments there are a plethora of new emerging therapies. By far immunotherapy represents the major revolution in oncology. While adoptive immunotherapy is still at the beginning, immune check-point inhibitors bursted in many clinical trials with very encouraging results. This review summarises the major discoveries in the field of HCC with an emphasis on immunotherapy. It also briefly describes the important aspects of primary liver cancer immunology and the major ongoing clinical trials.
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Affiliation(s)
- Iuliana Nenu
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Cluj-Napoca, Romania
- Liver Research Club, Cluj-Napoca, Romania
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulia Breaban
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Cluj-Napoca, Romania
- Liver Research Club, Cluj-Napoca, Romania
| | - Sorana Pascalau
- Liver Research Club, Cluj-Napoca, Romania
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina-Nelida Bora
- Liver Research Club, Cluj-Napoca, Romania
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horia Stefanescu
- Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, Cluj-Napoca, Romania
- Liver Research Club, Cluj-Napoca, Romania
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