Abstract
Conventional cytotoxic chemotherapy has not provided clinical benefit or prolonged survival for patients with advanced HCC. This review summarizes the results of prospective clinical trials of several categories of systemic therapy, with emphasis on the more promising results from recent trials of biologically targeted therapeutic agents in HCC.
Similar content being viewed by others
References
Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74–108
Parkin DM. The global burden of cancer. Semin Cancer Biol 1998;8:219–35
Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin 1999;49:33–64
Deuffic S, Poynard T, Buffat L, et al. Trends in primary liver cancer. Lancet 1998;351:214–5
Nagasue N, Kohno H, Chang YC, et al. Liver resection for hepatocellular carcinoma. Results of 229 consecutive patients during 11 years. Ann Surg 1993;217:375–84
Yamamoto S, Sato Y, Takeishi T, et al. Successful surgical treatment for hepatocellular carcinoma and concomitant risky esophageal varices. Hepatogastroenterology 2005;52:1083–6
Tanaka H, Kubo S, Tsukamoto T, et al. Recurrence rate and transplantability after liver resection in patients with hepatocellular carcinoma who initially met transplantation criteria. Transplant Proc 2005;37:1254–6
Simonetti RG, Camma C, Fiorello F, et al. Hepatocellular carcinoma. A worldwide problem and the major risk factors. Dig Dis Sci 1991;36:962–72
Johnson PJ. Hepatocellular carcinoma: is current therapy really altering outcome? Gut 2002;51:459–62
Johnson PJ. Are there indications for chemotherapy in hepatocellular carcinoma? Surg Oncol Clin N Am 2003;12:127–34
Palmer DH, Hussain SA, Johnson PJ. Systemic therapies for hepatocellular carcinoma. Expert Opin Investig Drugs 2004;13:1555–68
Hong RL, Tseng YL. A phase II and pharmacokinetic study of pegylated liposomal doxorubicin in patients with advanced hepatocellular carcinoma. Cancer Chemother Pharmacol 2003;51:433–8
Lee J, Park JO, Kim WS, et al. Phase II study of doxorubicin and cisplatin in patients with metastatic hepatocellular carcinoma. Cancer Chemother Pharmacol 2004;54:385–90
Okusaka T, Ueno H, Ikeda M: [Chemotherapy for hepatocellular carcinoma.] Gan To Kagaku Ryoho 2004;31:2122–8
Yeo W, Mok TS, Zee B, et al. A randomized phase III study of doxorubicin versus cisplatin/interferon alpha-2b/doxorubicin/fluorouracil (PIAF) combination chemotherapy for unresectable hepatocellular carcinoma. J Natl Cancer Inst 2005;97:1532–8
Gish RG, Porta C, Lazar L, et al. Phase III randomized controlled trial comparing the survival of patients with unresectable hepatocellular carcinoma treated with nolatrexed or doxorubicin. J Clin Oncol 2007;25:3069–75
Ratain MJ, Eisen T, Stadler WM, et al. Phase II placebo-controlled randomized discontinuation trial of sorafenib in patients with metastatic renal cell carcinoma. J Clin Oncol 2006;24:2505–12
Okada Y, Tosaka A, Nimura Y, et al. Atypical multidrug resistance may be associated with catalytically active mutants of human DNA topoisomerase II alpha. Gene 2001;272:141–8
Watanuki A, Ohwada S, Fukusato T, et al. Prognostic significance of DNA topoisomerase IIalpha expression in human hepatocellular carcinoma. Anticancer Res 2002;22:1113–9
Endicott JA, Ling V. The biochemistry of P-glycoprotein–mediated multidrug resistance. Annu Rev Biochem 1989;58:137–71
Ng IO, Liu CL, Fan ST, et al. Expression of P-glycoprotein in hepatocellular carcinoma. A determinant of chemotherapy response. Am J Clin Pathol 2000;113:355–63
Park JG, Lee SK, Hong IG, et al. MDR1 gene expression: its effect on drug resistance to doxorubicin in human hepatocellular carcinoma cell lines. J Natl Cancer Inst 1994;86:700–5
Tsang WP, Kwok TT. Riboregulator H19 induction of MDR1-associated drug resistance in human hepatocellular carcinoma cells. Oncogene 2007;26:4877–81
Chan KT, Lung ML. Mutant p53 expression enhances drug resistance in a hepatocellular carcinoma cell line. Cancer Chemother Pharmacol 2004;53:519–26
Zhu H, Chen XP, Luo SF, et al. Involvement of hypoxia-inducible factor-1-alpha in multidrug resistance induced by hypoxia in HepG2 cells. J Exp Clin Cancer Res 2005;24:565–74
Lasagna N, Fantappie O, Solazzo M, et al. Hepatocyte growth factor and inducible nitric oxide synthase are involved in multidrug resistance-induced angiogenesis in hepatocellular carcinoma cell lines. Cancer Res 2006;66:2673–82
Feng DY, Zheng H, Tan Y, et al. Effect of phosphorylation of MAPK and Stat3 and expression of c-fos and c-jun proteins on hepatocarcinogenesis and their clinical significance. World J Gastroenterol 2001;7:33–6
Ito Y, Sasaki Y, Horimoto M, et al. Activation of mitogen-activated protein kinases/extracellular signal-regulated kinases in human hepatocellular carcinoma. Hepatology 1998;27:951–8
McKillop IH, Schmidt CM, Cahill PA, et al. Altered expression of mitogen-activated protein kinases in a rat model of experimental hepatocellular carcinoma. Hepatology 1997;26:1484–91
Schmidt CM, McKillop IH, Cahill PA, et al. The role of cAMP-MAPK signalling in the regulation of human hepatocellular carcinoma growth in vitro. Eur J Gastroenterol Hepatol 1999;11:1393–9
Toyoda M, Hashimoto N, Tokita K, et al. Increased activity and expression of MAP kinase in HCC model rats induced by 3′-methyl-4-dimethylamino-azobenzene. J Hepatol 1999;31:725–33
Abou-Alfa GK, Schwartz L, Ricci S, et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006;24:4293–300
Llovet J, Ricci S, Mazzaferro V, et al. Sorafenib improves survival in advanced hepatocellular carcinoma (HCC): results of a phase III randomized placebo-controlled trial (SHARP trial). J Clin Oncol 2007;25(Suppl):LBA1
Alexia C, Bras M, Fallot G, et al. Pleiotropic effects of PI-3′ kinase/Akt signaling in human hepatoma cell proliferation and drug-induced apoptosis. Ann N Y Acad Sci 2006;1090:1–17
Kannangai R, Vivekanandan P, Martinez-Murillo F, et al. Fibrolamellar carcinomas show overexpression of genes in the RAS, MAPK, PIK3, and xenobiotic degradation pathways. Hum Pathol 2007;38:639–44
Saxena NK, Sharma D, Ding X, et al. Concomitant activation of the JAK/STAT, PI3K/AKT, and ERK signaling is involved in leptin-mediated promotion of invasion and migration of hepatocellular carcinoma cells. Cancer Res 2007;67:2497–507
Sieghart W, Fuereder T, Schmid K, et al. Mammalian target of rapamycin pathway activity in hepatocellular carcinomas of patients undergoing liver transplantation. Transplantation 2007;83:425–32
Sahin F, Kannangai R, Adegbola O, et al. mTOR and P70 S6 kinase expression in primary liver neoplasms. Clin Cancer Res 2004;10:8421–5
Ocker M, Alajati A, Ganslmayer M, et al. The histone-deacetylase inhibitor SAHA potentiates proapoptotic effects of 5-fluorouracil and irinotecan in hepatoma cells. J Cancer Res Clin Oncol 2005;131:385–94
Kanda T, Tada M, Imazeki F, et al. 5-aza-2′-deoxycytidine sensitizes hepatoma and pancreatic cancer cell lines. Oncol Rep 2005;14:975–9
Hisaka T, Yano H, Haramaki M, et al. Expressions of epidermal growth factor family and its receptor in hepatocellular carcinoma cell lines: relationship to cell proliferation. Int J Oncol 1999;14:453–60
Fausto N. Growth factors in liver development, regeneration and carcinogenesis. Prog Growth Factor Res 1991;3:219–34
Thomas MB, Chadha R, Glover K, et al. Phase 2 study of erlotinib in patients with unresectable hepatocellular carcinoma. Cancer 2007l110:1059–67
Philip PA, Mahoney MR, Allmer C, et al. Phase II study of Erlotinib (OSI-774) in patients with advanced hepatocellular cancer. J Clin Oncol 2005;23:6657–63
Yamaguchi R, Yano H, Iemura A, et al. Expression of vascular endothelial growth factor in human hepatocellular carcinoma. Hepatology 1998;28:68–77
Yamaguchi R, Yano H, Nakashima O, et al. Expression of vascular endothelial growth factor-C in human hepatocellular carcinoma. J Gastroenterol Hepatol 2006;21:152–60
Yamaguchi R, Yano H, Nakashima Y, et al. Expression and localization of vascular endothelial growth factor receptors in human hepatocellular carcinoma and non-HCC tissues. Oncol Rep 2000;7:725–9
El-Assal ON, Yamanoi A, Soda Y, et al. Clinical significance of microvessel density and vascular endothelial growth factor expression in hepatocellular carcinoma and surrounding liver: possible involvement of vascular endothelial growth factor in the angiogenesis of cirrhotic liver. Hepatology 1998;27:1554–62
Li Q, Xu B, Fu L, et al. Correlation of four vascular specific growth factors with carcinogenesis and portal vein tumor thrombus formation in human hepatocellular carcinoma. J Exp Clin Cancer Res 2006;25:403–9
Thomas MB, Chadha R, Iwasaki M, et al. The combination of bevacizumab (B) and erlotinib (E) shows significant biological activity in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2007;25(Suppl):4567
Gollob JA. Sorafenib: scientific rationales for single-agent and combination therapy in clear-cell renal cell carcinoma. Clin Genitourin Cancer 2005;4:167–74
Kamba T, McDonald DM. Mechanisms of adverse effects of anti-VEGF therapy for cancer. Br J Cancer 2007;96:1788–95
Karashima T, Inoue K, Fukata S, et al. Blockade of the vascular endothelial growth factor-receptor 2 pathway inhibits the growth of human renal cell carcinoma, RBM1-IT4, in the kidney but not in the bone of nude mice. Int J Oncol 2007;30:937–45
Rodriguez-Viciana P, Tetsu O, Oda K, et al. Cancer targets in the Ras pathway. Cold Spring Harb Symp Quant Biol 2005;70:461–7
Yorozuya K, Kubota T, Watanabe M, et al. TSU-68 (SU6668) inhibits local tumor growth and liver metastasis of human colon cancer xenografts via anti-angiogenesis. Oncol Rep 2005;14:677–82
Unitt E, Marshall A, Gelson W, et al. Tumour lymphocytic infiltrate and recurrence of hepatocellular carcinoma following liver transplantation. J Hepatol 2006;45:246–53
Blondon H, Fritsch L, Cherqui D. Two cases of spontaneous regression of multicentric hepatocellular carcinoma after intraperitoneal rupture: possible role of immune mechanisms. Eur J Gastroenterol Hepatol 2004;16:1355–9
Takayama T, Sekine T, Makuuchi M, et al. Adoptive immunotherapy to lower postsurgical recurrence rates of hepatocellular carcinoma: a randomised trial. Lancet 2000;356:802–7
Vollmer CM Jr., Eilber FC, Butterfield LH, et al. Alpha-fetoprotein-specific genetic immunotherapy for hepatocellular carcinoma. Cancer Res 1999;59:3064–7
Kawada M, Ikeda H, Takahashi T, et al. Vaccination of fusion cells of rat dendritic and carcinoma cells prevents tumor growth in vivo. Int J Cancer 2003;105:520–6
Lee WC, Wang HC, Hung CF, et al. Vaccination of advanced hepatocellular carcinoma patients with tumor lysate-pulsed dendritic cells: a clinical trial. J Immunother 2005;28:496–504
Kumagi T, Akbar SM, Horiike N, et al. Administration of dendritic cells in cancer nodules in hepatocellular carcinoma. Oncol Rep 2005;14:969–73
Sarobe P, Lasarte JJ, Zabaleta A, et al. Hepatitis C virus structural proteins impair dendritic cell maturation and inhibit in vivo induction of cellular immune responses. J Virol 2003;77:10862–71
Hylton N. Dynamic contrast-enhanced magnetic resonance imaging as an imaging biomarker. J Clin Oncol 2006;24:3293–8
Abratt RP, Reece WH, Enas NH, et al. Randomized phase II studies and their ethics. J Clin Oncol 2005;23:9443
Mok TS, Leung TW, Lee SD, et al. A multi-centre randomized phase II study of nolatrexed versus doxorubicin in treatment of Chinese patients with advanced hepatocellular carcinoma. Cancer Chemother Pharmacol 1999;44:307–11
Posey J, Johnson P, Mok T, et al. Results of a phase 2/3 open-label, randomized trial of T138067 versus doxorubicin (DOX) in chemotherapy-naïve, unresectable hepatocellular carcinoma (HCC). J Clin Oncol 2005;23(Suppl):4035
Patt YZ, Hassan MM, Lozano RD, et al. Thalidomide in the treatment of patients with hepatocellular carcinoma: a phase II trial. Cancer 2005;103:749–55
Pastorelli D, Cartei G, Zustovich F, et al. A phase II study of pegylated liposomial doxorubicin (PLD) and gemcitabine (G) in the treatment of hepatocellular carcinoma (HCC) not suitable for loco-regional therapy. J Clin Oncol 2007;25(Suppl):4585
Barbare JC, Bouche O, Bonnetain F, et al. Randomized controlled trial of tamoxifen in advanced hepatocellular carcinoma. J Clin Oncol 2005;23:4338–46
O’Neil BH, Allen R, Spigel DR, et al. High incidence of cetuximab-related infusion reactions in Tennessee and North Carolina and the association with atopic history. J Clin Oncol 2007;25:3644–8
Zhu AX, Blaszkowsky L, Enzinger PC, et al. Phase II study of cetuximab in patients with unresectable or metastatic hepatocellular carcinoma. J Clin Oncol 2006;24(Suppl):14096
O’Dwyer PJ, Giantonio BJ, Levy DE, et al. Gefitinib in advanced unresectable hepatocellular carcinoma: results from the Eastern Cooperative Oncology Group’s Study E1203. J Clin Oncol 2006;24:(Suppl):4143
Sun W, Haller DG, Mykulowycz K, et al. Combination of capecitabine, oxaliplatin with bevacizumab in treatment of advanced hepatocellular carcinoma (HCC): a phase II study. J Clin Oncol 2007;25(Suppl):4574
Zhu AX, Blaszkowsky LS, Ryan DP, et al. Phase II study of gemcitabine and oxaliplatin in combination with bevacizumab in patients with advanced hepatocellular carcinoma. J Clin Oncol 2006;24:1898–903
Author information
Authors and Affiliations
Corresponding author
Additional information
Proceedings of the 5th International Meeting Hepatocellular Carcinoma: Eastern and Western Experiences held in Houston, TX, January 11–13, 2007.
Rights and permissions
About this article
Cite this article
Thomas, M.B., O’Beirne, J.P., Furuse, J. et al. Systemic Therapy for Hepatocellular Carcinoma: Cytotoxic Chemotherapy, Targeted Therapy and Immunotherapy. Ann Surg Oncol 15, 1008–1014 (2008). https://doi.org/10.1245/s10434-007-9705-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-007-9705-0