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Diagnostics 2016, 6(4), 44; doi:10.3390/diagnostics6040044

First- and Second-Line Targeted Systemic Therapy in Hepatocellular Carcinoma—An Update on Patient Selection and Response Evaluation

I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Academic Editor: Andreas Kjaer
Received: 26 July 2016 / Revised: 22 November 2016 / Accepted: 23 November 2016 / Published: 28 November 2016
(This article belongs to the Collection Feature Papers)
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Abstract

Advanced hepatocellular carcinoma (HCC) with vascular invasion and/or extrahepatic spread and preserved liver function, according to stage C of the Barcelona Clinic Liver Cancer (BCLC) classification, has a dismal prognosis. The multi-targeted tyrosine-kinase receptor inhibitor (TKI) sorafenib is the only proven active substance in systemic HCC therapy for first-line treatment. In this review, we summarize current aspects in patient selection and management of side effects, and provide an update on response evaluation during first-line sorafenib therapy. Since second-line treatment options have been improved with the successful completion of the RESORCE trial, demonstrating a survival benefit for second-line treatment with the TKI regorafenib, response monitoring during first-line therapy will be critical to deliver optimal systemic therapy in HCC. To this regard, specific side effects, in particular worsening of arterial hypertension and diarrhea, might suggest treatment response during first-line sorafenib therapy; however, clear predictive clinical markers, as well as laboratory test or serum markers, are not established. Assessment of radiologic response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) is helpful to identify patients who do not benefit from sorafenib treatment. View Full-Text
Keywords: hepatocellular carcinoma; targeted systemic therapy; sorafenib; regorafenib; prediction of treatment response; mRECIST hepatocellular carcinoma; targeted systemic therapy; sorafenib; regorafenib; prediction of treatment response; mRECIST
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

von Felden, J.; Schulze, K.; Gil-Ibanez, I.; Werner, T.; Wege, H. First- and Second-Line Targeted Systemic Therapy in Hepatocellular Carcinoma—An Update on Patient Selection and Response Evaluation. Diagnostics 2016, 6, 44.

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