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Systemic Therapy for Hepatocellular Carcinoma: Cytotoxic Chemotherapy, Targeted Therapy and Immunotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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References

  1. Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74–108

    PubMed  Google Scholar 

  2. Parkin DM. The global burden of cancer. Semin Cancer Biol 1998;8:219–35

    Article  PubMed  CAS  Google Scholar 

  3. Parkin DM, Pisani P, Ferlay J. Global cancer statistics. CA Cancer J Clin 1999;49:33–64

    PubMed  CAS  Google Scholar 

  4. Deuffic S, Poynard T, Buffat L, et al. Trends in primary liver cancer. Lancet 1998;351:214–5

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  6. Yamamoto S, Sato Y, Takeishi T, et al. Successful surgical treatment for hepatocellular carcinoma and concomitant risky esophageal varices. Hepatogastroenterology 2005;52:1083–6

    PubMed  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. Johnson PJ. Hepatocellular carcinoma: is current therapy really altering outcome? Gut 2002;51:459–62

    Article  PubMed  CAS  Google Scholar 

  10. Johnson PJ. Are there indications for chemotherapy in hepatocellular carcinoma? Surg Oncol Clin N Am 2003;12:127–34

    Article  PubMed  Google Scholar 

  11. Palmer DH, Hussain SA, Johnson PJ. Systemic therapies for hepatocellular carcinoma. Expert Opin Investig Drugs 2004;13:1555–68

    Article  PubMed  CAS  Google Scholar 

  12. 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

    PubMed  CAS  Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. Okusaka T, Ueno H, Ikeda M: [Chemotherapy for hepatocellular carcinoma.] Gan To Kagaku Ryoho 2004;31:2122–8

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  CAS  Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  CAS  Google Scholar 

  19. 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

    PubMed  CAS  Google Scholar 

  20. Endicott JA, Ling V. The biochemistry of P-glycoprotein–mediated multidrug resistance. Annu Rev Biochem 1989;58:137–71

    Article  PubMed  CAS  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. 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

    Article  PubMed  CAS  Google Scholar 

  23. Tsang WP, Kwok TT. Riboregulator H19 induction of MDR1-associated drug resistance in human hepatocellular carcinoma cells. Oncogene 2007;26:4877–81

    Article  PubMed  CAS  Google Scholar 

  24. Chan KT, Lung ML. Mutant p53 expression enhances drug resistance in a hepatocellular carcinoma cell line. Cancer Chemother Pharmacol 2004;53:519–26

    Article  PubMed  CAS  Google Scholar 

  25. 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

    PubMed  CAS  Google Scholar 

  26. 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

    Article  PubMed  CAS  Google Scholar 

  27. 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

    PubMed  CAS  Google Scholar 

  28. 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

    Article  PubMed  CAS  Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. 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

    Article  PubMed  CAS  Google Scholar 

  31. 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

    Article  PubMed  CAS  Google Scholar 

  32. 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

    Article  PubMed  CAS  Google Scholar 

  33. 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

    Google Scholar 

  34. 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

    Article  PubMed  CAS  Google Scholar 

  35. 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

    Article  PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  CAS  Google Scholar 

  37. 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

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Article  PubMed  CAS  Google Scholar 

  39. 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

    Article  PubMed  CAS  Google Scholar 

  40. 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

    PubMed  Google Scholar 

  41. 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

    PubMed  CAS  Google Scholar 

  42. Fausto N. Growth factors in liver development, regeneration and carcinogenesis. Prog Growth Factor Res 1991;3:219–34

    Article  PubMed  CAS  Google Scholar 

  43. Thomas MB, Chadha R, Glover K, et al. Phase 2 study of erlotinib in patients with unresectable hepatocellular carcinoma. Cancer 2007l110:1059–67

  44. 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

    Article  PubMed  CAS  Google Scholar 

  45. Yamaguchi R, Yano H, Iemura A, et al. Expression of vascular endothelial growth factor in human hepatocellular carcinoma. Hepatology 1998;28:68–77

    Article  PubMed  CAS  Google Scholar 

  46. 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

    Article  PubMed  CAS  Google Scholar 

  47. 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

    PubMed  CAS  Google Scholar 

  48. 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

    Article  PubMed  CAS  Google Scholar 

  49. 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

    PubMed  CAS  Google Scholar 

  50. 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

    Google Scholar 

  51. Gollob JA. Sorafenib: scientific rationales for single-agent and combination therapy in clear-cell renal cell carcinoma. Clin Genitourin Cancer 2005;4:167–74

    Article  PubMed  CAS  Google Scholar 

  52. Kamba T, McDonald DM. Mechanisms of adverse effects of anti-VEGF therapy for cancer. Br J Cancer 2007;96:1788–95

    Article  PubMed  CAS  Google Scholar 

  53. 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

    PubMed  CAS  Google Scholar 

  54. 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

    Article  PubMed  CAS  Google Scholar 

  55. 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

    PubMed  CAS  Google Scholar 

  56. 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

    Article  PubMed  CAS  Google Scholar 

  57. 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

    Article  PubMed  Google Scholar 

  58. 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

    Article  PubMed  CAS  Google Scholar 

  59. Vollmer CM Jr., Eilber FC, Butterfield LH, et al. Alpha-fetoprotein-specific genetic immunotherapy for hepatocellular carcinoma. Cancer Res 1999;59:3064–7

    PubMed  CAS  Google Scholar 

  60. 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

    Article  PubMed  CAS  Google Scholar 

  61. 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

    Article  PubMed  Google Scholar 

  62. Kumagi T, Akbar SM, Horiike N, et al. Administration of dendritic cells in cancer nodules in hepatocellular carcinoma. Oncol Rep 2005;14:969–73

    PubMed  Google Scholar 

  63. 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

    Article  PubMed  CAS  Google Scholar 

  64. Hylton N. Dynamic contrast-enhanced magnetic resonance imaging as an imaging biomarker. J Clin Oncol 2006;24:3293–8

    Article  PubMed  CAS  Google Scholar 

  65. Abratt RP, Reece WH, Enas NH, et al. Randomized phase II studies and their ethics. J Clin Oncol 2005;23:9443

    Article  PubMed  Google Scholar 

  66. 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

    Article  PubMed  CAS  Google Scholar 

  67. 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

    Google Scholar 

  68. 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

    Article  PubMed  CAS  Google Scholar 

  69. 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

    Google Scholar 

  70. Barbare JC, Bouche O, Bonnetain F, et al. Randomized controlled trial of tamoxifen in advanced hepatocellular carcinoma. J Clin Oncol 2005;23:4338–46

    Article  PubMed  CAS  Google Scholar 

  71. 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

    Article  PubMed  Google Scholar 

  72. 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

    Google Scholar 

  73. 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

    Google Scholar 

  74. 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

    Google Scholar 

  75. 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

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Melanie B. Thomas MD.

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Proceedings of the 5th International Meeting Hepatocellular Carcinoma: Eastern and Western Experiences held in Houston, TX, January 11–13, 2007.

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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

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