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Angiogenesis in Hepatocellular Carcinoma; Pathophysiology, Targeted Therapy, and Role of Imaging

Authors Moawad AW, Szklaruk J, Lall C, Blair KJ, Kaseb AO, Kamath A, Rohren SA, Elsayes KM

Received 24 July 2019

Accepted for publication 24 December 2019

Published 23 April 2020 Volume 2020:7 Pages 77—89

DOI https://doi.org/10.2147/JHC.S224471

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Srikanta Dash


Ahmed W Moawad,1 Janio Szklaruk,1 Chandana Lall,2 Katherine J Blair,1 Ahmed O Kaseb,3 Amita Kamath,4 Scott A Rohren,5 Khaled M Elsayes1

1Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA; 2Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA; 3Department of Gastrointestinal Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA; 4Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, NY, USA; 5School of Medicine, Baylor College of Medicine, Houston, TX, USA

Correspondence: Khaled M Elsayes
Department of Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
Tel +1 713-745-3025
Fax +1 713-794-4379
Email kmelsayes@mdanderson.org

Abstract: Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide, usually occurring on a background of liver cirrhosis. HCC is a highly vascular tumor in which angiogenesis plays a major role in tumor growth and spread. Tumor-induced angiogenesis is usually related to a complex interplay between multiple factors and pathways, with vascular endothelial growth factor being a major player in angiogenesis. In the past decade, understanding of tumor-induced angiogenesis has led to the emergence of novel anti-angiogenic therapies, which act by reducing neo-angiogenesis, and improving patient survival. Currently, Sorafenib and Lenvatinib are being used as the first-line treatment for advanced unresectable HCC. However, a disadvantage of these agents is the presence of numerous side effects. A major challenge in the management of HCC patients being treated with anti-angiogenic therapy is effective monitoring of treatment response, which decides whether to continue treatment or to seek second-line treatment. Several criteria can be used to assess response to treatment, such as quantitative perfusion on cross-sectional imaging and novel/emerging MRI techniques, including a host of known and emerging biomarkers and radiogenomics. This review addresses the pathophysiology of angiogenesis in HCC, accurate imaging assessment of angiogenesis, monitoring effects of anti-angiogenic therapy to guide future treatment and assessing prognosis.

Keywords: angiogenesis, hepatocellular carcinoma, anti-angiogenic therapy, Sorafenib

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