Hepatocellular carcinoma (HCC) is a form of liver cancer that accounts for about 90% of all primary liver cancers. HCC is a growing public health problem, with an estimated 905,677 new cases and 830,180 deaths worldwide in 2020.

While there are several treatment options for HCC, including surgical resection, liver transplantation, and chemotherapy, the prognosis for patients with HCC remains poor. However, emerging trends and technologies in the management of HCC offer hope for better outcomes.

Targeted Therapies

Recent advances in understanding the molecular mechanisms of HCC have led to the development of targeted therapies. Targeted therapies work by blocking specific molecules or pathways involved in the growth and survival of cancer cells.

One example of a targeted therapy for HCC is sorafenib, an oral multikinase inhibitor that blocks the RAF/MEK/ERK pathway and the vascular endothelial growth factor receptor (VEGFR). Other targeted therapies for HCC under investigation include lenvatinib, regorafenib, cabozantinib, and ramucirumab.

Immunotherapy

Immunotherapy has emerged as a promising treatment approach for many cancers, including HCC. Immunotherapy works by enhancing the body’s immune response to cancer cells.

The most well-known type of immunotherapy is checkpoint inhibitors, which block proteins that prevent immune cells from attacking cancer cells. Nivolumab and pembrolizumab are checkpoint inhibitors that have been approved by the US FDA for the treatment of HCC. Other immunotherapies for HCC that are being studied include adoptive T-cell transfer, cancer vaccines, and oncolytic viruses.

Precision Medicine

Precision medicine is an approach that takes into account the unique characteristics of each patient’s tumor to tailor treatment.

This approach involves analyzing the genetic and molecular profile of the tumor to identify specific targets for therapy. Molecular profiling of HCC can identify mutations in genes such as TP53, CTNNB1, and AXIN1, which can inform treatment decisions.

Precision medicine also involves monitoring a patient’s response to treatment using tools such as liquid biopsies, which can detect circulating tumor DNA in the blood.

Minimally Invasive Surgery

Minimally invasive surgery (MIS) has been increasingly used in the management of HCC.

MIS techniques such as laparoscopic liver resection and radiofrequency ablation (RFA) offer several advantages over traditional open surgery, including less postoperative pain, faster recovery times, and shorter hospital stays. RFA involves using heat energy to destroy cancer cells, while laparoscopic liver resection involves removing part of the liver through small incisions with the aid of a camera.

Image-Guided Therapies

Image-guided therapies (IGTs) involve using imaging techniques such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) to deliver treatment to the site of the tumor.

IGTs for HCC include transcatheter arterial chemoembolization (TACE), which involves injecting chemotherapy directly into the blood vessels supplying the tumor, and stereotactic body radiation therapy (SBRT), which involves delivering high-dose radiation to the tumor in a few treatment sessions. IGTs are especially useful in cases where surgery is not possible, either due to the location of the tumor or the patient’s overall health status.

Artificial Intelligence

Artificial intelligence (AI) is being increasingly used in the management of HCC. AI techniques such as machine learning and deep learning can be used to analyze large amounts of radiological data to improve the accuracy of diagnosis and prognosis.

AI can also be used to develop predictive models to identify patients who are at high risk of developing HCC, allowing for earlier detection and intervention. Additionally, AI can be used to personalize treatment plans by taking into account patient-specific factors such as age, sex, and comorbidities.

Nanotechnology

Nanotechnology involves the manipulation of materials at the nanoscale (1-100 nanometers) and has potential applications in the management of HCC.

Nanoparticles can be used to deliver chemotherapy directly to the tumor, reducing toxicity to healthy tissues. Additionally, nanoparticles can be used to enhance the effectiveness of other treatments such as radiotherapy. Other potential applications of nanotechnology in HCC include imaging and diagnosis, as well as targeted drug delivery.

Liquid Biopsies

Liquid biopsies involve the analysis of biological fluids such as blood, urine, or cerebrospinal fluid to obtain information about a patient’s disease.

Liquid biopsies are non-invasive and can be performed more frequently than traditional tissue biopsies. In the context of HCC, liquid biopsies can be used to detect circulating tumor DNA, which can provide information about the genetic and molecular profile of the tumor.

Liquid biopsies can also be used to monitor treatment response and detect early signs of recurrence.

Robotic Surgery

Robotic surgery involves using a robotic system to perform surgical procedures. Robotic surgery offers several advantages over traditional open surgery, including improved visualization and precision, reduced blood loss, and shorter hospital stays.

Robotic surgery is increasingly being used in the management of HCC, particularly in cases where surgery is complex or involves removing tumors located in hard-to-reach areas of the liver.

Conclusion

The management of HCC is undergoing a revolution with the emergence of new trends and technologies. Targeted therapies, immunotherapy, precision medicine, and minimally invasive surgery offer new treatment options for patients with HCC.

Image-guided therapies, artificial intelligence, nanotechnology, liquid biopsies, and robotic surgery are providing new tools for diagnosis, monitoring, and treatment. With continued research and development, it is hoped that these emerging trends and technologies will lead to improved outcomes for patients with HCC.