Medical treatment of hepatocellular carcinoma.

Hepatocellular carcinoma is a rapidly fatal disease in most patients. In addition, many patients have underlying liver disease complicating their treatment. Prognostic factors have been found that identify a subset of patients who could benefit from therapy; though to date, chemotherapy, administered either intravenously or intra-arterially, has not altered the survival of patients who have advanced or recurrent disease. Patients with unfavorable prognostic factors, such as poor performance status, jaundice, or overt liver failure, should be offered only supportive care. Treatment with intravenous doxorubicin may be considered in better risk patients outside a clinical trial, although it has limited activity (less than 20 per cent response rate). Good performance status patients should be placed in clinical trials exploring both new ways to deliver therapy and promising new drugs.