Hepatocellular Carcinoma Treatment Protocols
- Author: Terence Rhodes, MD, PhD; Chief Editor: Jules E Harris, MD more...
Treatment Protocols
Treatment protocols for hepatocellular carcinoma are provided below, including those for patients with unresectable disease and patients with special considerations.
Treatment recommendations for patients with early-stage resectable disease
- For patients with early-stage hepatocellular carcinoma, a partial hepatectomy may be curative; however, a patient’s overall liver function, tumor assessment, and liver anatomy must be taken into consideration[1]
- Resection is recommended in patients who have preserved liver function, generally Child-Pugh class A (good operative risk) without portal hypertension
- Liver transplantation also offers patients a potential curative treatment option in early hepatocellular carcinoma
Treatment recommendations for patients with unresectable disease in whom local therapy has failed, who are not candidates for local therapy, or who have metastatic disease
- For patients who are not candidates for resection, liver transplantation should be offered to those who have a single tumor ≤ 5 cm in diameter or 2-3 tumors each ≤ 3 cm in diameter, who have no macrovascular involvement, or who have no extrahepatic disease[2]
- If feasible, locoregional therapies should be employed before systemic treatment for unresectable limited disease such as ablation (ie, radiofrequency, cryoablation, percutaneous alcohol injection, or microwave), transarterial chemoembolization, radioembolization (yttrium-90 microspheres), or stereotactic body radiotherapy and external-body radiotherapy
Systemic treatment recommendations for unresectable and advanced metastatic disease in patients with Child-Pugh score of A or B (moderate operative risk)
Patients diagnosed with advanced hepatocellular carcinoma are often recommended systemic treatment such as the following:
- Sorafenib 400 mg PO BID (it is common practice to start 200 mg daily, then 200 mg BID, escalating to 400 mg BID)[3]
- For moderate liver dysfunction, use 200 mg PO BID
- Use with extreme caution in patients with increased bilirubin levels[4]
Although the National Comprehensive Cancer Network (NCCN)[1] recommends systemic chemotherapy only in clinical trials, the following regimens have shown marginal activity in small clinical trials:
- Gemcitabine 1000 mg/m2 IV on day 1 plus oxaliplatin 100 mg/m2 on day 2; then every 14d[5]or
- Capecitabine 1000 mg/m2 PO BID on days 1-14 plus oxaliplatin 130 mg/m2 IV on day 1; then every 21d[6]or
- Capecitabine 1000 mg/m2 PO BID on days 1-14; then every 21d[7]or
- Doxorubicin 60-75 mg/m2 IV on day 1; then every 21d[8, 9]or
- Gemcitabine 1250 mg/m2 IV on days 1 and 8 plus cisplatin 35 mg/m2 IV on days 1 and 8; then every 21d[10, 11]
NCCN Hepatobiliary Cancers Clinical Practice Guidelines in Oncology. Available at http://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf. Accessed May 12, 2011.
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