HEPATOCARCINOMA is the most common liver cancer, and the fourth leading cause of cancer death in our country. It has an incidence that fluctuates around 12-13 thousand new diagnoses every year and is a particular neoplasm, because it almost always occurs in patients with known risk factors. Over 70% of new diagnoses are attributable to pre-existing liver disease, whether it is cirrhosis linked to viral hepatitis or alcohol abuse, or fatty liver associated with metabolic dysfunction: fatty infiltrations in the liver that arise in people suffering from metabolic syndrome, obesity, diabetes and hypertension. “Thanks to the hepatitis B vaccine and the new antivirals that have revolutionized the treatment of hepatitis C, cancers caused by these diseases are on the decline today, and will become increasingly rare in the future,” he explains. Lorenza Rimassa, Associate Professor of Medical Oncology and Director of the School of Specialization in Medical Oncology of Humanitas University of Milan. “For this reason – he adds – hepatocarcinoma is a neoplasm that can more and more often be prevented by choosing a correct lifestyle: avoiding alcohol and tobacco, exercising and sticking to a balanced diet are choices that can maintain health us and our liver, and that drastically reduce the chances of developing liver cancer “.
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If detected early, this tumor can be treated surgically, with a good chance of recovery, especially in patients who can undergo a liver transplant. In the most advanced stages, however, the surgical path is no longer viable, and the prognosis unfortunately becomes poor. “This is why at-risk patients are monitored with ultrasound scans performed every six months, to ensure the best chance of detecting the onset of a tumor in the early stages”, he points out. Bruno Daniele, head of the Oncology of the Hospital of the Sea of Naples: “Unfortunately, today this is only possible for those suffering from viral hepatitis, and therefore the tumors caused by alcohol abuse, obesity and metabolic problems are almost always identified in more advanced stages of illness “.
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In the so-called intermediate phase, when the tumor is still limited to the liver, but too large to be operated on, local treatments such as chemoembolization are used. In patients with advanced cancer, which has reached important vessels such as the portal vein or caused extra hepatic metastases, however, the only therapeutic option is that of drugs that help slow the progression of the disease. And although the prognosis, unfortunately, remains poor, there has been significant progress in this area in recent years. “Until about fifteen years ago we had practically no effective therapy – remembers Rimassa – then in 2007 sorafenib arrived, a multikinase inhibitor that was the first to improve survival in these patients, and remained the only therapy available. for about 10 years. Only recently the therapies available to us have increased rapidly. “
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Today, second and third lines of treatment are also available, to be used when the previous ones prove ineffective. And just in the last year a combination therapy has appeared, which has proved to be superior both in terms of efficacy, and for a lower incidence of side effects and a better quality of life, establishing itself as the therapy of choice at the level international. This is the combination of two monoclonal antibodies, which is about to be approved by AIFA also in our country: atezolizumab, an immunotherapy that pushes the immune system to attack cancer cells, and bevacizumab, which inhibits the formation of new vessels. blood from the tumor. And that’s not all, because experts await the results of the trials of new therapies in the coming months. And with a constantly growing pharmacological arsenal, a new season in liver cancer treatment is sure to open. Precisely for this reason, the ability to better manage patients at all stages of their care path will become increasingly important. “To undergo the therapies you need good liver function, and only the treatment of patients by a multidisciplinary team, which includes oncologist, hepatologist, surgeon, interventional radiologist, pathologist, offers patients the best chance of maintaining it”, he concludes. Daniele: “In Italy this is guaranteed in many regions within regional networks and in large hospitals, and we are the only country in Europe where the prognosis for liver cancer has improved in recent years. However, some regional differences remain. that should be overcome, to ensure the best possible care for all patients “.
Article originally published in Salute of December 30, 2021
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