Future Treatment Option for Hepatocellular Carcinoma: A Focus on Brivanib

Hepatocellular carcinoma (HCC), one of the most common cancers worldwide, is particularly prevalent in the Asia-Pacific region. Guidelines on the treatment of HCC in Japan come from both consensus-based and evidence-based treatment algorithms. However, patients with extensive liver damage and/or more advanced disease (major vascular invasion and/ or extrahepatic spread) are currently ineligible for any treatment. Recent knowledge of hepatocarcinogenesis has led to the targeting of new pathways, particularly the angiogenic pathway, with a specific focus on the vascular endothelial growth factor receptor (VEGFR). Apparently the most studied systemic antiangiogenic agent for HCC is sorafenib. An updated version of the aforementioned treatment algorithms recommends sorafenib therapy for advanced HCC patients with Child-Pugh A liver function and extrahepatic spread or major vascular invasion. Moreover, sorafenib is recommended for use in HCC patients who are refractory or intolerant to transarterial chemoembolization (TACE) with well-preserved liver function (Child-Pugh A). However, one of the unresolved issues is anti-VEGF resistance. It is speculated that novel antiangiogenic agents that combine inhibition of other pathways such as fibroblast growth factor Masatoshi Kudo, MD, PhD Department of Gastroenterology and Hepatology Kinki University School of Medicine 377-2, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511 (Japan) Tel. +81 72 366 0221 ext. 3149, E-Mail m-kudo @ med.kindai.ac.jp © 2011 S. Karger AG, Basel 0257–2753/11/0293–0316$38.00/0 Accessible online at: www.karger.com/ddi D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /2 3/ 20 17 4 :1 6: 21 P M