Effective therapeutic management of hepatocellular carcinoma – on the basis of a clinical case

The prognosis of patients suffering from primary hepatocellular carcinoma (HCC) is unfavourable because the tumour usually develops in cirrhosis-affected liver and is typically not diagnosed until an advanced stage of the disease. The 5-year survival rate for HCC patients in Europe does not exceed 9%. On the basis of a clinical case, the present article discusses the strategy of treatment of HCC patients. Patients with advanced HCC, stage C according to the Barcelona Clinic Liver Cancer (BCLC) staging system, typically receive systemic chemotherapy with sorafenib. The standard management in the treatment of intermediate-stage HCC, i.e. BCLC's stage B, is chemoembolization (TACE). However, repeated TACE sessions activate factors involved in the process of angiogenesis such as hypoxia-inducible factor-1 (HIF-1) and vascular endothelial growth factor (VEGF), which can render the procedure ineffective. Therefore, there are scientific foundations for combining TACE with antiangiogenic agents such as sorafenib. Results of studies conducted to date indicate that the combination of sorafenib with TACE in patients with BCLC's stage B brings tangible therapeutic effects while being safe. The value of this therapeutic strategy is confirmed by the case described below, in which TACE + sorafenib have induced a partial regression of HCC.