Improved chemotherapy for hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common cancer and it is the third leading cause of cancer-related deaths worldwide. Once diagnosed with the disease, only 30-40% of patients are deemed eligible for curative intention with treatment modalities including surgical resection, liver transplantation, and chemoembolization. Eventually, most patients will receive some forms of chemotherapy in hope of prolonging life. Sorafenib is the first molecular inhibitor to be approved by the FDA for the treatment of advanced HCC. It is a tyrosine kinase inhibitor, targeting multiple molecular pathways. Prior to the arrival of sorafenib, doxorubicin was routinely used as a single drug for advanced HCC, but has shown inefficacy, with a response rate of about 15-20%. Other chemotherapy agents, such as epirubicin, cisplatin, 5-fluorouracil, etoposide and their combinations, demonstrate even lower efficacy. While being considered an advance over conventional chemotherapy, sorafenib only improves life expectancy approximately by 3 months over placebo. With that in mind, continuous efforts have been put into finding new targets and molecular pathways for possible new drug development. In this article, we summarize the current literature over the past year on chemotherapy treatment of advanced HCC.