The management of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. As a tumor that predictably develops in patients with known underlying liver disease, mostly in cirrhosis, it is imperative that effective screening and surveillance strategies be implemented to identify the disease at a stage when it is curable. For early stage cirrhotic patients without prohibitive portal hypertension and with compensated liver function, surgical resection is the goal. Locoregional therapies include ablative, transarterial, and radiation-based therapies, which have a critical role in controlling the tumor, and may allow for unresectable patients with disease confined to the liver to be bridged or downstaged prior to curative-intent liver transplantation, unequivocally the gold-standard treatment for early stage patients with unresectable HCC. For locally advanced and metastatic HCC patients who are not candidates for locoregional or surgical therapy, the last few years have seen many successes with the approval of numerous targeted therapies and immunotherapies in both front line and second line. With an increasing characterization of the underlying genomic, transcriptomic, proteomic, and epigenetic aberrations that impact HCC tumor biology, there is renewed hope for the discovery of additional targeted therapies to treat tumor recurrence and allow for precision oncology approaches to patients with this deadly malignancy.