Selecting a Treatment Regimen
ÎAlcohol injection and radiofrequency are equally effective for tumors < 2 cm. However, the necrotic effect of radiofrequency ablation (RFA) is more predictable in all tumor sizes, and in addition its efficacy is clearly superior to that of alcohol injection in larger tumors (I).
ÎTransarterial chemoembolization (TACE) is recommended as first line noncurative therapy for nonsurgical patients with large or multifocal HCC who do not have vascular invasion or extrahepatic spread (I).
ÎSorafenib is recommended as a first line option in patients who have preserved liver function but cannot benefit from resection, transplantation, ablation or TACE (I).
ÎRadioembolization with Yttrium-90-labeled glass beads has been shown to induce extensive tumor necrosis with an acceptable safety profile. However, there are no studies demonstrating an impact on survival. Hence its value in the clinical setting has not been established and cannot be recommended as standard therapy for advanced HCC outside clinical trials (II).
ÎTamoxifen, anti-androgens, octreotide or hepatic artery ligation/embolization are NOT recommended (I).
ÎSystemic or selective intraarterial chemotherapy is NOT recommended and should NOT be used as standard of care (II).
Table 2. FDA-Approved Drug for HCC Drug (Brand)
Dose Sorafenib (NEXAVAR® ) 400 mg bid without food