The management of
hepatocellular carcinoma (HCC) has substantially changed in the past few decades. Improvements in patient stratification (for example, using the Barcelona Clinic
Liver Cancer staging system) and the introduction of novel
therapies (such as
sorafenib) have improved patient survival. Nevertheless, HCC remains the third most common cause of
cancer-related deaths worldwide. Decision-making largely relies on evidence-based criteria, as depicted in the US and European clinical practice guidelines, which endorse five therapeutic recommendations: resection;
transplantation;
radiofrequency ablation; chemoembolization; and
sorafenib. However, areas still exist in which uncertainty precludes a strong recommendation, such as the role of adjuvant
therapies after resection, radioembolization with
yttrium-90 or second-line
therapies for advanced HCC. Many clinical trials that are currently ongoing aim to answer these questions. The first reported studies, however, failed to identify novel therapeutic alternatives (that is,
sunitinib,
erlotinib or
brivanib). Moreover, genomic profiling has enabled patient classification on the basis of molecular parameters, and has facilitated the development of new effective drugs. However, no
oncogene addiction loops have been identified so far, as has been the case with other
cancers such as
melanoma, lung or
breast cancer. Efforts that focus on the implementation of
personalized medicine approaches in HCC will probably dominate research in the next decade.