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Sorafenib in Advanced Hepatocellular Carcinoma: Therapeutic Approach and Future Research

January-March 2017, Volume 12, Number 1
Mireia Gil Raga, Vega Iranzo González-Cruz and María José Safont Aguilera
Medical Oncology Department, Sagunto Hospital, Valencia, Spain

Hepatocarcinoma is the most common liver tumor and usually occurs in patients with chronic hepatic disease. Hepatocarcinoma should be understood as a multi-step process involving the accumulation of genetic and epigenetic alterations. Patient stratification and therapeutic decision making is based on the Barcelona Clinic Liver Cancer classification. In advanced disease the prognosis is poor and the systemic treatment options do not impact survival. Sorafenib, an orally active multi-kinase inhibitor with anti-angiogenic and anti-proliferative effects, is the only drug that has demonstrated in two large, multicenter, double-blind, placebo-controlled, randomized phase III studies an increase in survival in patients with advanced and unresectable disease and enriched Child-Pugh class A. Sorafenib-related adverse events include hand-foot skin reaction, rash, diarrhea, fatigue, and hypertension. In recent years, thanks to increased knowledge on the hepatocarcinogenesis and immunogenicity of hepatocarcinoma, new lines of research with multiple targeted drugs have been opened. To date, only regorafenib has demonstrated survival benefit in patients who have progressed to sorafenib in a randomized phase III trial. Level expression of MET is a promising prognostic and predictive biomarker with tivantinib. Finally, immunotherapy has shown promising results in hepatocarcinoma patients, as in other immunogenic tumors.

Key words:
Hepatocellular carcinoma. Primary liver cancer. Sorafenib. Tyrosine kinase inhibitor. Targeted therapy.
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