A primer hepatocellularis rák kezelése [Treatment of primary hepatocellular carcinoma]

摘要

Primary hepatocellular cancer is the fifth most common solid tumor worldwide. Its incidence is the highest in the Third World, however, a risen incidence has been observed recently also in developed countries, due to increasing migration. In Asia and Africa the main etiological factor for HCC is chronic HBV infection, whereas in the Western world HCV etiology predominates. Additional increase in HCC incidence is expected as a consequence of climate change, since risk of aflatoxin contamination in agricultural products increases with hot and dry growing conditions. Aflatoxins are the most potent hepatocarcinogens in nature; therefore minimization of aflatoxin exposition will be a main task of food security in the future. The majority of HCC patients are diagnosed in advanced stages, and treatment possibilities are limited for this patient population. Follow-up of risk populations by means of tumor surveillance is therefore essential. Experience with systemic chemotherapy has been disappointing with low response rates and high toxicity. Recently, novel treatment options have emerged, including the use of specific targeted agents, blockers of signaling pathways involved in hepatocarcinogenesis. Sorafenib, an oral multikinase-inhibitor is the first systemic agent to demonstrate survival benefit in advanced hepatocellular cancer. Several new, promising therapeutic options are being tested in clinical trials.