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3. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma.

Author

Lai, Quirino, De Matthaeis, Nicoletta, Finotti, Michele, Galati, Giovanni, Marrone, Giuseppe, Melandro, Fabio, Morisco, Filomena, Nicolini, Daniele, Pravisani, Riccardo, Giannini, Edoardo G., A, Aglitti, C, Aliberti, U, Baccarani, S, Bhoori, M, Borzio, G, Brancaccio, P, Burra, G, Cabibbo, A, Casadei Gardini, and P, Carrai

Subjects
HEPATOCELLULAR carcinoma, MORTALITY, ODDS ratio, OVERALL survival, CONFIDENCE intervals
Abstract

Aim: To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment. Methods: A systematic literature search was performed using PubMed and Cochrane Central Register of Controlled Trials Databases. Two HCC clinical settings were explored: (i) incidence, and (ii) death after any HCC treatment. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the pooled data between patients who received or did not receive APT. Results: A total of 20 studies were identified, of whom 15 focused on HCC incidence, including 2,685,009 patients, and five on post‐treatment death, including 3281 patients. APT was associated with an overall reduced risk of HCC incidence (OR: 0.63; 95%CI = 0.51–0.79; p < 0.001) as well as of post‐treatment mortality (OR: 0.54; 95%CI = 0.35–0.83; p = 0.006). Conclusions: Current data suggest that APT correlated with higher HCC incidence and poor overall survival following tumour treatment. [ABSTRACT FROM AUTHOR]

Published
2023
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4. Effect of direct-acting antivirals on future occurrence of hepatocellular carcinoma in compensated cirrhotic patients

Author

Cucchetti, Alessandro, D’Amico, Gennaro, Trevisani, Franco, Morelli, Maria Cristina, Vitale, Alessandro, Pinna, Antonio Daniele, Cescon, Matteo, Cillo, Umberto, Burra, Patrizia, Russo, Francesco P., Mescoli, Claudia, Rendina, Maria, Lupo, Luigi G., Losito, Francesco, Fucilli, Fabio, Brancaccio, Giusep-Pina, Persico, Marcello, Viganò, Luca, Iavarone, Massimo, D’Ambrosio, Roberta, Sangiovanni, Angelo, Renzulli, Matteo, Galati, Giovanni, Ponziani, Francesca Romana, Pompili, Maurizio, Miele, Luca, Grieco, Antonio, Rapaccini, Gianlodovico, Gasbarrini, Antonio, Sandri, Giovanni Battisa Levi, Lai, Quirino, Melandro, Fabio, Rossi, Massimo, Lenci, Ilaria, Manzia, Tommaso Maria, Tortora, Raffaella, Di Costanzo, Giovan Giuseppe, Sacco, Rodolfo, Simonetti, Natalia, Morisco, Filomena, Guarino, Maria, Cabibbo, Giuseppe, Bhoori, Carlo Sposito Sherrie, Di Sandro, Stefano, Foschi, Francesco Giuseppe, Gardini, Andrea Casadei, Nicolini, Daniele, Mazzocato, Susanna, Alba, Kostandini, Violi, Paola, Baccarani, Umberto, Pravisani, Riccardo, A. Cucchetti, G. D'Amico, F. Trevisani, M.C. Morelli, A. Vitale, A.D.Pinna, M. Cescon, Cucchetti, Alessandro, D’Amico, Gennaro, Trevisani, Franco, Morelli, Maria Cristina, Vitale, Alessandro, Pinna, Antonio Daniele, Cescon, Matteo, Cillo, Umberto, Burra, Patrizia, Russo, Francesco P., Mescoli, Claudia, Rendina, Maria, Lupo, Luigi G., Losito, Francesco, Fucilli, Fabio, Brancaccio, Giusep-Pina, Persico, Marcello, Viganò, Luca, Iavarone, Massimo, D’Ambrosio, Roberta, Sangiovanni, Angelo, Renzulli, Matteo, Galati, Giovanni, Ponziani, Francesca Romana, Pompili, Maurizio, Miele, Luca, Grieco, Antonio, Rapaccini, Gianlodovico, Gasbarrini, Antonio, Sandri, Giovanni Battisa Levi, Lai, Quirino, Melandro, Fabio, Rossi, Massimo, Lenci, Ilaria, Manzia, Tommaso Maria, Tortora, Raffaella, Di Costanzo, Giovan Giuseppe, Sacco, Rodolfo, Simonetti, Natalia, Morisco, Filomena, Guarino, Maria, Cabibbo, Giuseppe, Bhoori, Carlo Sposito Sherrie, Di Sandro, Stefano, Foschi, Francesco Giuseppe, Gardini, Andrea Casadei, Nicolini, Daniele, Mazzocato, Susanna, Alba, Kostandini, Violi, Paola, Baccarani, Umberto, and Pravisani, Riccardo

Subjects
Male, Time Factors, Sustained Virologic Response, Hepatocellular carcinoma, Hepacivirus, Direct-acting antiviral, Direct-acting antivirals, medicine.disease_cause, Gastroenterology, Competing risk, Hepatitis C, Markov model, Survival benefit, Sustained virological response, Hepatology, 0302 clinical medicine, Risk Factors, 030212 general & internal medicine, biology, Incidence, Incidence (epidemiology), Liver Neoplasms, Middle Aged, Markov Chains, Competing risk Direct-acting antivirals Hepatitis C Hepatocellular carcinoma Markov model Survival benefit Sustained virological response, Italy, Liver Neoplasm, Female, 030211 gastroenterology & hepatology, Human, Adult, medicine.medical_specialty, Carcinoma, Hepatocellular, Time Factor, Hepatitis C virus, Antiviral Agents, 03 medical and health sciences, Internal medicine, medicine, Humans, Antiviral Agent, Hepaciviru, business.industry, Risk Factor, Carcinoma, Hepatocellular, Markov Chain, medicine.disease, biology.organism_classification, digestive system diseases, Settore MED/18 - Chirurgia Generale, Liver function, Varices, business
Abstract

Background: The achievement of high rates of sustained virological response (SVR) with direct-acting antivirals (DAAs) in hepatitis C virus (HCV) infected patients will reduce decompensating terminal events. Aims: To investigate whether hepatocellular carcinoma (HCC) occurrence could change due to the DAA-induced increase in life-expectancy. Methods: A Markov model was built on clinical data of 494 cirrhotic patients and available literature to estimate probabilities of “death before HCC” and of “HCC occurrence” without and with DAA. Results: In comparison to untreated patients, DAA therapy reduced the 20-year mortality before HCC by 21.9% in patients without varices and by 21.5% in those with varices, considering an SVR of 95% and no direct effect on hepatocarcinogenesis. Tumour occurrence increased by 5%–8.2% and the proportion of HCCs diagnosed in compensated stages increased to >98%. If we consider DAA as having “anti-tumoral” effects, the benefit becomes greater, achieving a 20-year survival of 81.5% in patients without varices, and 52.2% in patients with varices. Instead, if we consider DAA as having a “pro-tumoral” effect, then, the increased incidence of HCC nullifies the survival benefits. Conclusion: DAAs drastically reduce the mortality caused by the liver function worsening, increasing the proportion of HCCs diagnosed in compensated stages. Knowledge of the DAA effect on hepatocarcinogenesis remains pivotal. © 2017 Editrice Gastroenterologica Italiana S.r.l.

Published
2018

5. Recurrence of hepatocellular carcinoma after direct acting antiviral treatment for hepatitis C virus infection: Literature review and risk analysis

Author

Guarino, Maria, Viganò, Luca, Ponziani, Francesca Romana, Giannini, Edoardo Giovanni, Lai, Quirino, Morisco, Filomena, Vitale, Alessandro, Russo, Francesco Paolo, Cillo, Umberto, Burra, Patrizia, Mescoli, Claudia, Gambato, Martina, Sessa, Anna, Cabibbo, Giuseppe, Viganò, Mauro, Galati, Giovanni, Villa, Erica, Iavarone, Massimo, Brancaccio, Giuseppina, Rendina, Maria, Lupo, Luigi G., Losito, Francesco, Fucilli, Fabio, Persico, Marcello, D'Ambrosio, Roberta, Sangiovanni, Angelo, Cucchetti, Alessandro, Trevisani, Franco, Matteo, Renzulli, Miele, Luca, Grieco, Antonio, Lodovico Rapaccini, Gian, Pompili, Maurizio, Gasbarrini, Antonio, Battisa Levi Sandri, Giovanni, Melandro, Fabio, Rossi, Massimo, Lenci, Ilaria, Manzia, Tommaso Maria, Tortora, Raffaella, Di Costanzo, Giovan Giuseppe, Sacco, Rodolfo, Ghinolfi, Davide, Rreka, Erion, Carrai, Paola, Simonetti, Natalia, Sposito, Carlo, Bhoori, Sherrie, di Sandro, Stefano, Foschi, Francesco Giuseppe, Casadei Gardini, Andrea, Nicolini, Daniele, Mazzocato, Susanna, Kostandini, Alba, Violi, Paola, Baccarani, Umberto, Pravisani, Riccardo, Vincenzi, Valter, ROSA MARIA, Guarino, Luca, Viganò, Francesca Romana, Ponziani, Edoardo Giovanni, Giannini, Quirino, Lai, Filomena, Morisco, Alessandro, Vitale, Russo, Francesco Paolo, Umberto, Cillo, Patrizia, Burra, Claudia, Mescoli, Martina, Gambato, Anna, Sessa, Cabibbo, Giuseppe, Viganò, Mauro, Galati, Giovanni, Erica, Villa, Iavarone, Massimo, Brancaccio, Giuseppina, Maria, Rendina, Luigi G., Lupo, Francesco, Losito, Fabio, Fucilli, Marcello, Persico, Roberta, D'Ambrosio, Angelo, Sangiovanni, Alessandro, Cucchetti, Franco, Trevisani e Matteo Renzulli, Luca, Miele, Antonio, Grieco, Gian, Lodovico Rapaccini, Maurizio, Pompili, Antonio, Gasbarrini, Giovanni, Battisa Levi Sandri, Fabio, Melandro, Massimo, Rossi, Ilaria, Lenci, Tommaso, Maria Manzia, Raffaella, Tortora, Giovan Giuseppe, Di Costanzo, Sacco, Rodolfo, Davide, Ghinolfi, Erion, Rreka, Paola, Carrai, Natalia, Simonetti, Carlo, Sposito, Sherrie, Bhoori, Stefano, di Sandro, Francesco Giuseppe, Foschi, Andrea, Casadei Gardini, Daniele, Nicolini, Susanna, Mazzocato, Kostandini, Alba, Paola, Violi, Umberto, Baccarani, Riccardo, Pravisani, Valter, Vincenzi, Guarino, Maria, Viganò, Luca, Ponziani, Francesca Romana, Giannini, Edoardo Giovanni, Lai, Quirino, Morisco, Filomena, Vitale, Alessandro, Cillo, Umberto, Burra, Patrizia, Mescoli, Claudia, Gambato, Martina, Sessa, Anna, Villa, Erica, Rendina, Maria, Lupo, Luigi G., Losito, Francesco, Fucilli, Fabio, Persico, Marcello, D'Ambrosio, Roberta, Sangiovanni, Angelo, Cucchetti, Alessandro, Trevisani e Matteo Renzulli, Franco, Miele, Luca, Grieco, Antonio, Lodovico Rapaccini, Gian, Pompili, Maurizio, Gasbarrini, Antonio, Battisa Levi Sandri, Giovanni, Melandro, Fabio, Rossi, Massimo, Lenci, Ilaria, Manzia, Tommaso Maria, Tortora, Raffaella, Di Costanzo, Giovan Giuseppe, Ghinolfi, Davide, Rreka, Erion, Carrai, Paola, Simonetti, Natalia, Sposito, Carlo, Bhoori, Sherrie, di Sandro, Stefano, Foschi, Francesco Giuseppe, Casadei Gardini, Andrea, Nicolini, Daniele, Mazzocato, Susanna, Violi, Paola, Baccarani, Umberto, Pravisani, Riccardo, Vincenzi, Valter, CASADEI GARDINI, Andrea, Trevisani, Franco, and Matteo, Renzulli

Subjects
Oncology, Liver Cirrhosis, Cirrhosis, Sustained Virologic Response, DAA, HCC, HCV, Recurrence, medicine.disease_cause, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Antiviral Agents, Carcinoma, Hepatocellular, Disease Progression, Hepatitis C, Chronic, Humans, Liver Neoplasms, Neoplasm Recurrence, Local, Neoplasm Staging, Risk Assessment, Chronic, Gastroenterology, hepatocellular carcinoma, Hepatitis C, Local, Hepatology, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, 030211 gastroenterology & hepatology, Risk assessment, Direct acting, Risk analysis, medicine.medical_specialty, Hepatitis C virus, DAA, HCC, HCV, Recurrence, 03 medical and health sciences, Internal medicine, medicine, Antiviral treatment, business.industry, Carcinoma, Hepatocellular, medicine.disease, Settore MED/18 - Chirurgia Generale, Neoplasm Recurrence, business
Abstract

Although studies suggest decreased incident hepatocellular carcinoma (HCC) after treatment with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection, data are conflicting regarding risk and aggressiveness of recurrence in patients who have a history of treated HCC. This review analyses data available in literature in order to elucidate the impact of DAAs on the risk of HCC recurrence after successful treatment of the tumor. Overall 24 papers were identified. The available data cannot be considered definitive, but the initial alarmist data indicating an increased risk of recurrence have not been confirmed by most subsequent studies. The suggested aggressive pattern (rapid growth and vascular invasion) of tumor recurrence after DAAs still remains to be confirmed. Several limitations of the available studies were highlighted, and should drive future researches. The time-to-recurrence should be computed since the last HCC treatment and results stratified for cirrhosis and sustained viral response. Any comparison with historical series is of limited interest because of a number of biases affecting these studies and differences between enrolled patients. Prospective intention-to-treat analyses will be probably the best contribution to drive clinical practice, provided that a randomized trial can be difficult to design.

Published
2018

6. Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows

Author

Guarino, Maria, Sessa, Anna, Cossiga, Valentina, Morando, Federica, Caporaso, Nicola, Morisco, Filomena, Luca, Viganó, Romana, Ponziani Francesca, Maurizio, Pompili, Cillo, Umberto, Burra, Patrizia, Mescoli, Claudia, Gambato, Martina, Russo, FRANCESCO PAOLO, Vitale, Alessandro, Giuseppe, Cabibbo, Mauro, Vigano', Giovanni, Galati, Erica, Villa, Lupo, Luigi G., Maria, Rendina, Losito, Francesco, Fucilli, Fabio, Persico, Marcello, D'Ambrosio, Roberta, Sangiovanni, Angelo, Massimo, Iavarone, Brancaccio, Giuseppina, Cucchetti, Alessandro, Renzulli, Matteo, Franco, Trevisani, Miele, Luca, Grieco, Antonio, Rapaccini, Gianlodovico, Gasbarrini, Antonio, Sandri, Giovanni Battisa Levi, Melandro, Fabio, Rossi, Massimo, Quirino, Lai, Lenci, Ilaria, Manzia, Tommaso Maria, Tortora, Raffaella, Di Costanzo, Giovan Giuseppe, Ghinolfi, Davide, Rreka, Erion, Carrai, Paola, Simonetti, Natalia, Rodolfo, Sacco, Sposito, Carlo, Bhoori, Sherrie, Di Sandro, Stefano, Foschi, Francesco Giuseppe, Gardini, Andrea Casadei, Nicolini, Daniele, Mazzocato, Susanna, Alba, Kostandini, Violi, Paola, Baccarani, Umberto, Pravisani, Riccardo, Vincenzi, Valter, Maria, Guarino, Anna, Sessa, Valentina, Cossiga, Federica, Morando, Nicola, Caporaso, Filomena, Morisco, Viganó, Luca, Ponziani Francesca, Romana, Pompili, Maurizio, Umberto, Cillo, Patrizia, Burra, Claudia, Mescoli, Martina, Gambato, Russo Francesco, Paolo, Vitale, Alessandro, Cabibbo, Giuseppe, Vigano', Mauro, Galati, Giovanni, Villa, Erica, Luigi G., Lupo, Rendina, Maria, Francesco, Losito, Fabio, Fucilli, Marcello, Persico, Roberta, D'Ambrosio, Angelo, Sangiovanni, Iavarone, Massimo, Brancaccio, Giuseppina, Alessandro, Cucchetti, Matteo, Renzulli, Trevisani, Franco, Luca, Miele, Antonio, Grieco, Gianlodovico, Rapaccini, Antonio, Gasbarrini, Giovanni Battisa Levi, Sandri, Fabio, Melandro, Massimo, Rossi, Lai, Quirino, Ilaria, Lenci, Tommaso Maria, Manzia, Raffaella, Tortora, Giovan Giuseppe, Di Costanzo, Davide, Ghinolfi, Erion, Rreka, Paola, Carrai, Natalia, Simonetti, Sacco, Rodolfo, Carlo, Sposito, Sherrie, Bhoori, Stefano, Di Sandro, Francesco Giuseppe, Foschi, Andrea Casadei, Gardini, Daniele, Nicolini, Susanna, Mazzocato, Kostandini, Alba, Paola, Violi, Umberto, Baccarani, Riccardo, Pravisani, Valter, Vincenzi, Guarino, Maria, Sessa, Anna, Cossiga, Valentina, Morando, Federica, Caporaso, Nicola, Morisco, Filomena, Luca, Viganó, Romana, Ponziani Francesca, Maurizio, Pompili, Cillo, Umberto, Burra, Patrizia, Mescoli, Claudia, Gambato, Martina, Paolo, Russo Francesco, Alessandro, Vitale, Giuseppe, Cabibbo, Mauro, Vigano', Giovanni, Galati, Erica, Villa, Lupo, Luigi G., Maria, Rendina, Losito, Francesco, Fucilli, Fabio, Persico, Marcello, D'Ambrosio, Roberta, Sangiovanni, Angelo, Massimo, Iavarone, Giuseppina, Brancaccio, Cucchetti, Alessandro, Renzulli, Matteo, Franco, Trevisani, Miele, Luca, Grieco, Antonio, Rapaccini, Gianlodovico, Gasbarrini, Antonio, Sandri, Giovanni Battisa Levi, Melandro, Fabio, Rossi, Massimo, Quirino, Lai, Lenci, Ilaria, Manzia, Tommaso Maria, Tortora, Raffaella, Di Costanzo, Giovan Giuseppe, Ghinolfi, Davide, Rreka, Erion, Carrai, Paola, Simonetti, Natalia, Rodolfo, Sacco, Sposito, Carlo, Bhoori, Sherrie, Di Sandro, Stefano, Foschi, Francesco Giuseppe, Gardini, Andrea Casadei, Nicolini, Daniele, Mazzocato, Susanna, Alba, Kostandini, Violi, Paola, Baccarani, Umberto, Pravisani, Riccardo, and Vincenzi, Valter

Subjects
Oncology, Cirrhosis, Direct-acting antiviral agent, Sustained Virologic Response, Direct-acting antiviral agents, Hepatitis C virus, Hepatocellular carcinoma, Occurrence, Recurrence, Antiviral Agents, Carcinoma, Hepatocellular, Disease Progression, Hepacivirus, Hepatitis C, Chronic, Humans, Incidence, Liver, Liver Neoplasms, Neoplasm Recurrence, Local, Risk Factors, Treatment Outcome, Gastroenterology, medicine.disease_cause, DIRECT ACTING ANTIVIRALS, 0302 clinical medicine, Chronic, biology, Incidence (epidemiology), Minireviews, General Medicine, Hepatitis C, Local, Liver Neoplasm, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Human, medicine.medical_specialty, Interferon therapy, 03 medical and health sciences, Chronic hepatitis, Internal medicine, medicine, Antiviral Agent, Hepaciviru, business.industry, Risk Factor, Carcinoma, Hepatocellular, medicine.disease, biology.organism_classification, digestive system diseases, Settore MED/18 - Chirurgia Generale, Neoplasm Recurrence, business, Hepatitis C viru
Abstract

With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum "not well-defined" followup: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection. © 2018 The Author(s). Published by Baishideng Publishing Group Inc. All rights reserved.

Published
2018

7. Minimally Invasive Approach in the Setting of ALPPS Procedure: a Systematic Review of the Literature.

Author

Melandro, Fabio, Giovanardi, Francesco, Hassan, Redan, Larghi Laureiro, Zoe, Ferri, Flaminia, Rossi, Massimo, Mennini, Gianluca, Pawlik, Timothy M., and Lai, Quirino

Subjects
*PORTAL vein surgery, *META-analysis, *MINIMALLY invasive procedures, *PORTAL vein, *COLON diseases, *COLON tumors, *COMPARATIVE studies, *ENDOSCOPIC surgery, *HEPATECTOMY, *HEPATOCELLULAR carcinoma, *LENGTH of stay in hospitals, *LIGATURE (Surgery), *LIVER tumors, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *EVALUATION research, *TREATMENT effectiveness, RECTUM tumors
Abstract

Background: Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a new surgical technique for the resection of advanced hepatic malignancies with predicted insufficient future liver remnant. In some patients, ALPPS can be associated with an increased risk of poor outcomes. Minimally invasive surgery (MIS) has been proposed in combination with ALPPS with the intent to minimize this risk. We systematically evaluated the outcomes of MIS-ALPPS cases to compare the relative outcomes of open ALPPS versus MIS-ALPPS.Methods: A systematic review was done in accordance with the PRISMA guidelines. Search terms utilized included the following: ("ALPPS"[Title/Abstract] OR "associating liver partition and portal vein ligation for staged hepatectomy"[Title/Abstract] OR "in situ split"[Title/Abstract]) AND ("minimally invasive"[Title/Abstract] OR "laparoscopic"[Title/Abstract] OR "robotic"[Title/Abstract]).Results: Fifteen articles were identified, with a total of 27 patients reported. Colorectal metastatic disease was the most commonly observed indication for MIS-ALPPS (66.7%), followed by hepatocellular carcinoma (25.9%). Time passed from the first to the second stage ranged 7-30 days. MIS-ALPPS patients did not experience procedure failures between the first and second stages. Only four (15.4%) subjects had a grade IIIb complication. No perioperative mortality after the first or second stage was reported. Compared with open ALPPS, MIS-ALPPS demonstrated better results. Hospital stay duration ranged 8-33 days with a follow-up ranging 1-20 months.Conclusions: MIS-ALPPS appears to be safe, with potentially lower morbidities and mortalities relative to open patients. The present results should be considered with caution. A limited number of articles exist on this topic. Furthermore, selection biases exist when comparing open versus MIS-ALPPS data. Registry studies are needed to better define the outcomes of patients undergoing MIS-ALPPS. [ABSTRACT FROM AUTHOR]

Published
2019
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8. Alpha-Fetoprotein and Novel Tumor Biomarkers as Predictors of Hepatocellular Carcinoma Recurrence after Surgery: A Brilliant Star Raises Again

Author

Lai, Quirino, Melandro, Fabio, Pinheiro, 1 Rafael S., 2 Andrea Donfrancesco, Fadel, 3 Bashir A., LEVI SANDRI, GIOVANNI BATTISTA, Rossi, Massimo, Berloco, Pasquale Bartolomeo, 1, and Frattaroli, Fabrizio Maria

Subjects
Curative intent, Oncology, medicine.medical_specialty, Pathology, Hepatology, business.industry, Hepatic resection, medicine.medical_treatment, Review Article, Liver transplantation, medicine.disease, digestive system diseases, Clinical Practice, Tumor Biomarkers, Hepatocellular carcinoma, Internal medicine, medicine, In patient, lcsh:Diseases of the digestive system. Gastroenterology, lcsh:RC799-869, business, Alpha-fetoprotein, neoplasms, Alpha-Fetoprotein
Abstract

Alpha-fetoprotein (AFP), des-γ-carboxy prothrombin (DCP), and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) have been developed with the intent to detect hepatocellular carcinoma (HCC) and for the surveillance of at-risk patients. However, at present, none of these tests can be recommended to survey cirrhotic patients at risk for HCC development because of their suboptimal ability for routine clinical practice in HCC diagnosis. Starting from these considerations, these markers have been therefore routinely and successfully used as predictors of survival and HCC recurrence in patients treated with curative intent. All these markers have been largely used as predictors in patients treated with hepatic resection or locoregional therapies, mainly in Eastern countries. In recent studies, AFP has been proposed as predictor of recurrence after liver transplantation and as selector of patients in the waiting list. Use of AFP modification during the waiting list for LT is still under investigation, potentially representing a very interesting tool for patient selection. The development of a new predictive model combining radiological and biological features based on biological markers is strongly required. New genetic markers are continuously discovered, but they are not already fully available in the clinical practice.

Published
2012

9. Overview of Immune Checkpoint Inhibitors Therapy for Hepatocellular Carcinoma, and The ITA.LI.CA Cohort Derived Estimate of Amenability Rate to Immune Checkpoint Inhibitors in Clinical Practice.

Author

Giannini, Edoardo G., Aglitti, Andrea, Borzio, Mauro, Gambato, Martina, Guarino, Maria, Iavarone, Massimo, Lai, Quirino, Levi Sandri, Giovanni Battista, Melandro, Fabio, Morisco, Filomena, Ponziani, Francesca Romana, Rendina, Maria, Russo, Francesco Paolo, Sacco, Rodolfo, Viganò, Mauro, Vitale, Alessandro, and Trevisani, Franco

Subjects
ANTIGENS, ANTINEOPLASTIC agents, HEPATOCELLULAR carcinoma, IMMUNOTHERAPY, EVALUATION of medical care, GUT microbiome, BLOCKING antibodies, PHARMACODYNAMICS
Abstract

Despite progress in our understanding of the biology of hepatocellular carcinoma (HCC), this tumour remains difficult-to-cure for several reasons, starting from the particular disease environment where it arises—advanced chronic liver disease—to its heterogeneous clinical and biological behaviour. The advent, and good results, of immunotherapy for cancer called for the evaluation of its potential application also in HCC, where there is evidence of intra-hepatic immune response activation. Several studies advanced our knowledge of immune checkpoints expression in HCC, thus suggesting that immune checkpoint blockade may have a strong rationale even in the treatment of HCC. According to this background, initial studies with tremelimumab, a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor, and nivolumab, a programmed cell death protein 1 (PD-1) antibody, showed promising results, and further studies exploring the effects of other immune checkpoint inhibitors, alone or with other drugs, are currently underway. However, we are still far from the identification of the correct setting, and sequence, where these drugs might be used in clinical practice, and their actual applicability in real-life is unknown. This review focuses on HCC immunobiology and on the potential of immune checkpoint blockade therapy for this tumour, with a critical evaluation of the available trials on immune checkpoint blocking antibodies treatment for HCC. Moreover, it assesses the potential applicability of immune checkpoint inhibitors in the real-life setting, by analysing a large, multicentre cohort of Italian patients with HCC. [ABSTRACT FROM AUTHOR]

Published
2019
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