Abstract:
Masovian Oncological Hospital, Warsaw, Poland
Patients with hepatocellular carcinoma (HCC) remains a
challenge in oncology, necessitating a multidisciplinary
approach for effective treatment. The main challenge in
patients with HCC, is not only dealing with cancer itself but
also with liver cirrhosis of different origin, an underlying
cause of HCC. For the successful management of HCC,
integration of the Barcelona Clinic Liver Cancer (BCLC) is
necessary, emphasizing its pivotal role in guiding treatment
decisions and prognostication. BCLC classification
stratifies HCC patients into distinct stages based on tumor
burden, liver function, and performance status, thereby
facilitating individualized management strategies. Earlystage
HCC (BCLC 0-A) is characterized by well-preserved
liver function and small, solitary tumors amenable to
curative therapies such as liver resection, liver
transplantation, or local ablation. Intermediate-stage
disease (BCLC B) encompasses patients with multifocal
tumors or vascular invasion, often managed with
locoregional therapies like transarterial
chemoembolization (TACE) or radioembolization.
Advanced-stage HCC (BCLC C) includes patients with
extensive disease or extrahepatic spread, for whom
systemic therapies are recommended. Finally, end-stage
HCC (BCLC D) denotes patients with decompensated liver
function or performance status, warranting best supportive
care. The current standard of care in the unresectable or
metastatic HCC is the combination of the treatment of
atezolizumab (anti- programmed death ligand 1
PD-L1) with bevacizumab (anti-vascular endothelial
growth factor, VEGF), based on the result of phase 3 trial
IMbrave150 study. In certain cases, multikinase inhibitors
can be considered, like Sorafenib, based on the results of
SHARP study, or Lenvatinib. Patients amenageable for the
systemic treatment are those with Child–Pugh liver
function class A, and good performance status. Patients
with HCC demand a multidisciplinary approach, clinicians
should integrate the BCLC classification in the
management of those patients. Furthermore, the therapeutic
modalities of systemic treatment in HCC are evolving and
should be implemented in the management of HCC
patients.
