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Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma

Because diagnostic tools for discriminating between hepatocellular carcinoma (HCC) and advanced cirrhosis are poor, HCC is often detected in a stage where transarterial chemoembolization (TACE) is the best treatment option, even though it provides a poor survival gain. Despite having been used world...

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Autores principales: Ebeling Barbier, Charlotte, Heindryckx, Femke, Lennernäs, Hans
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658005/
https://www.ncbi.nlm.nih.gov/pubmed/34884853
http://dx.doi.org/10.3390/ijms222313051
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author Ebeling Barbier, Charlotte
Heindryckx, Femke
Lennernäs, Hans
author_facet Ebeling Barbier, Charlotte
Heindryckx, Femke
Lennernäs, Hans
author_sort Ebeling Barbier, Charlotte
collection PubMed
description Because diagnostic tools for discriminating between hepatocellular carcinoma (HCC) and advanced cirrhosis are poor, HCC is often detected in a stage where transarterial chemoembolization (TACE) is the best treatment option, even though it provides a poor survival gain. Despite having been used worldwide for several decades, TACE still has many limitations. First, there is a vast heterogeneity in the cellular composition and metabolism of HCCs as well as in the patient population, which renders it difficult to identify patients who would benefit from TACE. Often the delivered drug does not penetrate sufficiently selectively and deeply into the tumour and the drug delivery system is not releasing the drug at an optimal clinical rate. In addition, therapeutic effectiveness is limited by the crosstalk between the tumour cells and components of the cirrhotic tumour microenvironment. To improve this widely used treatment of one of our most common and deadly cancers, we need to better understand the complex interactions between drug delivery, local pharmacology, tumour targeting mechanisms, liver pathophysiology, patient and tumour heterogeneity, and resistance mechanisms. This review provides a novel and important overview of clinical data and discusses the role of the tumour microenvironment and lymphatic system in the cirrhotic liver, its potential response to TACE, and current and possible novel DDSs for locoregional treatment.
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spelling pubmed-86580052021-12-10 Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma Ebeling Barbier, Charlotte Heindryckx, Femke Lennernäs, Hans Int J Mol Sci Review Because diagnostic tools for discriminating between hepatocellular carcinoma (HCC) and advanced cirrhosis are poor, HCC is often detected in a stage where transarterial chemoembolization (TACE) is the best treatment option, even though it provides a poor survival gain. Despite having been used worldwide for several decades, TACE still has many limitations. First, there is a vast heterogeneity in the cellular composition and metabolism of HCCs as well as in the patient population, which renders it difficult to identify patients who would benefit from TACE. Often the delivered drug does not penetrate sufficiently selectively and deeply into the tumour and the drug delivery system is not releasing the drug at an optimal clinical rate. In addition, therapeutic effectiveness is limited by the crosstalk between the tumour cells and components of the cirrhotic tumour microenvironment. To improve this widely used treatment of one of our most common and deadly cancers, we need to better understand the complex interactions between drug delivery, local pharmacology, tumour targeting mechanisms, liver pathophysiology, patient and tumour heterogeneity, and resistance mechanisms. This review provides a novel and important overview of clinical data and discusses the role of the tumour microenvironment and lymphatic system in the cirrhotic liver, its potential response to TACE, and current and possible novel DDSs for locoregional treatment. MDPI 2021-12-02 /pmc/articles/PMC8658005/ /pubmed/34884853 http://dx.doi.org/10.3390/ijms222313051 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ebeling Barbier, Charlotte
Heindryckx, Femke
Lennernäs, Hans
Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma
title Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma
title_full Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma
title_fullStr Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma
title_full_unstemmed Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma
title_short Limitations and Possibilities of Transarterial Chemotherapeutic Treatment of Hepatocellular Carcinoma
title_sort limitations and possibilities of transarterial chemotherapeutic treatment of hepatocellular carcinoma
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658005/
https://www.ncbi.nlm.nih.gov/pubmed/34884853
http://dx.doi.org/10.3390/ijms222313051
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