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Current Oncology
Volume 27
Issue 2
10.3747/co.27.5891
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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
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Article

Nonsurgical Management of Advanced Hepatocellular Carcinoma: A Clinical Practice Guideline

by
B.M. Meyers
1,*,†,
J. Knox
2,†,
R. Cosby
3,
J.R. Beecroft
4,
K.K.W. Chan
5,
N. Coburn
5,
J. Feld
6,
D. Jonker
7,
A. Mahmud
8,
J. Ringash
9 and
the Gastrointestinal Disease Site Group
1
Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, ON, Canada
2
Princess Margaret Cancer Centre, Toronto, ON, Canada
3
Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, ON, Canada
4
Department of Medical Imaging, Mount Sinai Hospital, and University Health Network, Toronto, ON, Canada
5
Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
6
Toronto General Hospital Research Institute, Toronto, ON, Canada
7
The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
8
Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
9
Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this guideline.
Curr. Oncol. 2020, 27(2), 106-114; https://doi.org/10.3747/co.27.5891
Submission received: 7 February 2020 / Revised: 6 March 2020 / Accepted: 5 April 2020 / Published: 1 May 2020

Abstract

Background: Practice guidelines based on a systematic review of the literature regarding the nonsurgical management of hepatocellular carcinoma (hcc) in North America are lacking. Resection and transplantation are the foundations for cure of hcc; however, most patients are diagnosed at an advanced stage, precluding those curative treatments. A number of local or regional therapies are used and are followed by systemic therapy for advanced or progressive disease. Other treatments are available, but their efficacy, compared with those standards, is not well known. Methods: First, systematic review questions were developed. Literature searches of the medline, embase, and Cochrane library databases (January 2000 to July 2018 or January 2005 to July 2018 depending on the question) were conducted; in addition, abstracts from the 2018 annual meeting of the American Society of Clinical Oncology were reviewed. A practice guideline was drafted that was then scrutinized by internal and external reviewers. Results: Seventy-seven studies were included in the guideline: no guidelines, two systematic reviews, and seventy-five primary studies published in full (including one pooled analysis). Five recommendations were developed. Conclusions: There is no evidence for or against the use of local or regional interventions other than transarterial chemoembolization for the treatment of intermediate- or advanced-stage hcc. Furthermore, there is no evidence to support the addition of sorafenib to any local or regional therapy. Sorafenib or lenvatinib are recommended for first-line systemic treatment of intermediate-stage hcc. Regorafenib or cabozantinib provide survival benefits when given as second-line treatment. Antiviral treatment is recommended in individuals with advanced hcc who are positive for the hepatitis B surface antigen.
Keywords: nonsurgical treatments; hepatocellular carcinoma; practice guidelines; systemic therapy; tyrosine kinase inhibitors nonsurgical treatments; hepatocellular carcinoma; practice guidelines; systemic therapy; tyrosine kinase inhibitors

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MDPI and ACS Style

Meyers, B.M.; Knox, J.; Cosby, R.; Beecroft, J.R.; Chan, K.K.W.; Coburn, N.; Feld, J.; Jonker, D.; Mahmud, A.; Ringash, J.; et al. Nonsurgical Management of Advanced Hepatocellular Carcinoma: A Clinical Practice Guideline. Curr. Oncol. 2020, 27, 106-114. https://doi.org/10.3747/co.27.5891

AMA Style

Meyers BM, Knox J, Cosby R, Beecroft JR, Chan KKW, Coburn N, Feld J, Jonker D, Mahmud A, Ringash J, et al. Nonsurgical Management of Advanced Hepatocellular Carcinoma: A Clinical Practice Guideline. Current Oncology. 2020; 27(2):106-114. https://doi.org/10.3747/co.27.5891

Chicago/Turabian Style

Meyers, B.M., J. Knox, R. Cosby, J.R. Beecroft, K.K.W. Chan, N. Coburn, J. Feld, D. Jonker, A. Mahmud, J. Ringash, and et al. 2020. "Nonsurgical Management of Advanced Hepatocellular Carcinoma: A Clinical Practice Guideline" Current Oncology 27, no. 2: 106-114. https://doi.org/10.3747/co.27.5891

APA Style

Meyers, B. M., Knox, J., Cosby, R., Beecroft, J. R., Chan, K. K. W., Coburn, N., Feld, J., Jonker, D., Mahmud, A., Ringash, J., & the Gastrointestinal Disease Site Group. (2020). Nonsurgical Management of Advanced Hepatocellular Carcinoma: A Clinical Practice Guideline. Current Oncology, 27(2), 106-114. https://doi.org/10.3747/co.27.5891

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