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Onkologische Welt 2010; 01(05): 203-209
DOI: 10.1055/s-0038-1632892
Gastro-Onkologie
Schattauer GmbH

Das Hepatozelluläre Karzinom: Update 2010

Hepatocellular carcinoma: update 2010
L.-A. Sun
1   Abteilung Innere Medizin IV, Hepatologie und Gastroenterologie, Medizinische Klinik (Krehl-Klinik), Universität Heidelberg
,
A. Langhein
1   Abteilung Innere Medizin IV, Hepatologie und Gastroenterologie, Medizinische Klinik (Krehl-Klinik), Universität Heidelberg
,
M. Müller
1   Abteilung Innere Medizin IV, Hepatologie und Gastroenterologie, Medizinische Klinik (Krehl-Klinik), Universität Heidelberg
› Author Affiliations
Further Information

Publication History





Publication Date:
02 February 2018 (online)

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Zusammenfassung

Das hepatozelluläre Karzinom (HCC) ist weltweit die dritthäufigste krebsbedingte Todesursache. 90 % aller HCCs entstehen auf dem Boden einer vorbestehenden Lebererkrankung oder Zirrhose. Screening und Surveillance von Patienten mit chronischer Lebererkrankung ermöglichen die Früherkennung eines hepatozellulären Karzinoms (HCC). Die Wahl der Therapie für Patienten mit HCC richtet sich nach der Leberfunktion, der Tumorgröße, dem Tumorbefallsmuster und dem Allgemeinzustand der Patienten. Patienten mit HCC im Frühstadium können mittels chirurgischer Resektion, Lebertransplantation oder lokal ablativer Verfahren geheilt werden. Patienten mit fort-geschrittenem HCC können von Behandlungen mit transarterieller Chemoembolisation, mit Selektiver Interner Radiotherapie (SIRT) und mit dem Tyrosinkinase-Inhibitor Sorafenib profitieren. Sorafenib ist die erste systemische Therapie, die beim fortgeschrittenen HCC zu einer Verlängerung des Gesamtüberlebens führt. Sorafenib ist daher neuer Standard in der Behandlung des fortgeschrittenen HCC. Eine Reihe von neuen zielgerichteten onkologischen Therapien wird derzeit im Rahmen von klinischen Studien evaluiert. Signalwege, die gezielt von möglichen molekularen Therapien beeinflusst werden können, sind die gesteigerte Angiogenese, Wachstumsfaktor-Rezeptoren und Signaltransduktionswege, die zur Vermittlung von Proliferationssignalen führen.

Summary

The incidence of hepatocellular carcinoma (HCC) is increasing in most countries and HCC is currently the leading cause of death in patients with cirrhosis. Surveillance programs aim to detect tumors at an early stage. Curative treatments for early stage tumors include liver transplantation (LTX), resection and percutaneous ablation. Transarterial chemoembolization can improve survival for non-surgical patients with intermediate stage tumors who do not have vascular invasion or extrahepatic spread. Radioembolization with Yttrium90-labeled glass beads has been shown to induce extensive tumour necrosis; up to date, there are no studies demonstrating an impact on survival. The multikinase inhibitor Sorafenib has shown survival benefits in patients at advanced stages of HCC. These results prove that molecular targeted therapies can be effective in this tumor. Consequently, sorafenib has become the standard of care in advanced stage HCC for patients who can not benefit from resection, liver transplantation, ablation or transarterial chemoembolization. Several novel molecular therapies in addition to Sorafenib are now being tested within clinical trials in HCC patients. Several key molecular pathways in HCC represent rational targets for novel therapies. Current and future clinical trials could identify new effective systemic agents, combination systemic therapies, and combined modality options.

Schlüsselwörter

Hepatozelluläres Karzinom - Diagnose - Staging - Therapie Algorithmus - Lebertransplantation - Sorafenib - molekulare Therapie - lokal ablative Therapien

Keywords

Hepatocellular Carcinoma - diagnosis - staging systems - treatment algorithm - liver transplantation - Sorafenib - targeted therapy - loco ablative therapies
 

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