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KMID : 1048120130020020078
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International Journal of Gastrointestinal Intervention
2013 Volume.2 No. 2 p.78 ~ p.81
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Molecular targeted therapy with transarterial chemoembolization
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Yu Su-Jong
Yoon Jung-Hwan
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Abstract
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Hepatocellular carcinoma (HCC) remains the third most common cause of cancer-related deaths worldwide, although improvements in patient stratification and the introduction of novel therapies have improved patient survival. Despite surveillance programs, 80% of HCCs are diagnosed at an advanced stage, at which point noncurative treatment, including transarterial chemoembolization (TACE) or sorafenib, is indicated. In intermediate stage HCC, suboptimal treatment outcomes are usually associated with a high rate of recurrence after TACE by eliciting a reaction from vascular endothelial growth factor. The modest anti-cancer benefits of sorafenib, an anti-angiogenic agent, coupled with its adverse effect profile are two additional barriers to overcome in treating advanced HCC. Considering the limitations of TACE and sorafenib in intermediate to advanced stage HCC patients, the potential benefits of combination therapy are attractive. Besides sorafenib, many novel agents are under investigation in Phase III trials of advanced HCC. However, to date nothing has been shown to perform better than sorafenib. Moreover, recently presented efficacy results evaluating a combination of TACE with molecularly targeted therapies including sorafenib are less impressive. While TACE or anti-angiogenic therapies results in tumor hypoxia and cell death, this may also activate hypoxia-induced survival signals including hexokinase II, carbonic anhydrase IX, or protein disulfide isomerase. To overcome this situation, the inhibition of hypoxia-induced survival signals might be additionally required as an adjuvant therapy following TACE or anti-angiogenic therapies. Therefore, further basic experiments and clinical studies are required to enhance the therapeutic potency of TACE for HCC.
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KEYWORD
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Hepatocellular carcinoma, Molecularly targeted therapy, Transarterial chemoembolization
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