[Multimodal treatment of hepatocellular carcinoma]. / Multimodale Therapie des hepatozellulären Karzinoms.

Hepatocellular carcinoma (HCC) is one of the most common and most lethal cancers worldwide. Treatment of patients with HCC is complicated by the underlying liver disease in up to 80% of all cases. Interdisciplinary and multimodal treatment strategies are essential for successful therapy. Established therapies include surgical interventions (liver transplantation, resection), local ablative therapies (e.g., microwave or radiofrequency ablation), and locoregional therapies (e.g., transarterial chemoembolization [TACE] and selective internal radiotherapy [SIRT/TARE]). Moreover, there are emerging opportunities for systemic therapies. While the multityrosine kinase inhibitor sorafenib has been the only agent approved for patients with unresectable HCC for almost a decade, there are now additional systemic treatment options including the tyrosine kinase inhibitors (TKIs) lenvatinib, regorafenib, and cabozantinib as well as the VEGF-receptor inhibitor ramucirumab. To date, immune checkpoint inhibitor monotherapies have failed to show an overall survival benefit, but according to recent data combined immunotherapy/VEGF inhibition has shown superior activity in first-line treatment compared with sorafenib. The advent of numerous novel systemic agents offers a variety of combination opportunities. Combinations of systemic agents with locoregional treatments in palliative and potentially curative settings are currently being investigated. Today, treatment of patients with HCC is more challenging than ever owing to the multiple therapeutic options available, demanding strict multidisciplinary cooperation in the treatment selection process. There is an urgent need for clinical studies in order to further optimize the therapy sequence and to identify efficacious mono- and combination therapies.

The impact of the revolution in hepatitis C treatment on hepatocellular carcinoma.

Hepatitis C infection represents a global health problem affecting ∼200 million chronically infected patients worldwide. Owing to the development of a fibrogenic and inflammatory micromilieu in the liver, hepatitis C virus (HCV)-infected patients are at a high risk of developing fibrosis, cirrhosis and hepatocellular carcinoma (HCC). The advent of direct-acting antiviral agents (DAAs), however, has spurred a revolution in the treatment of HCV patients with sustained viral response (SVR) rates exceeding 90% in real-life settings. Recent clinical trials suggest that these novel treatments will not only alter the epidemiology of HCV infection but also the incidence of HCV-induced complications including hepatic decompensation, liver transplantation and hepatocarcinogenesis. Here, we summarize data from clinical trials carried out in HCV patients with compensated and decompensated cirrhosis and analyze the impact of viral clearance on HCC development and treatment. Finally, we review and discuss current and future treatment options of HCV patients with HCC in pre- and post-transplantation settings.