Enhancing the management of hepatocellular carcinoma - oncologist perspective

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.