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Targeted therapy and personalized medicine in hepatocellular carcinoma: drug resistance, mechanisms, and treatment strategies

Authors Galun D, Srdic-Rajic T, Bogdanovic A, Loncar Z, Zuvela M

Received 24 February 2017

Accepted for publication 20 May 2017

Published 11 July 2017 Volume 2017:4 Pages 93—103

DOI https://doi.org/10.2147/JHC.S106529

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 2

Editor who approved publication: Professor Ahmed O Kaseb

Danijel Galun,1,2 Tatjana Srdic-Rajic,3 Aleksandar Bogdanovic,1 Zlatibor Loncar,2,4 Marinko Zuvela1,2

1Hepato-Pancreato-Biliary Unit, University Clinic for Digestive Surgery, Clinical Center of Serbia, 2Medical School, University of Belgrade, 3Institute for Oncology and Radiology of Serbia/Unit for Experimental Oncology, 4Emergency Center, Clinical Center of Serbia, Belgrade, Serbia

Abstract: Hepatocellular carcinoma (HCC) is characterized by a growing number of new cases diagnosed each year that is nearly equal to the number of deaths from this cancer. In a majority of the cases, HCC is associated with the underlying chronic liver disease, and it is diagnosed in advanced stage of disease when curative treatment options are not applicable. Sorafenib is a treatment of choice for patients with performance status 1 or 2 and/or macrovascular invasion or extrahepatic spread, and regorafenib is the only systemic treatment found to provide survival benefit in HCC patients progressing on sorafenib treatment. Other drugs tested in different trials failed to demonstrate any benefit. Disappointing results of numerous trials testing the efficacy of various drugs indicate that HCC has low sensitivity to chemotherapy that is in great part caused by multidrug resistance. Immunotherapy for HCC is a new challenging treatment option and involves immune checkpoint inhibitors/antibody-based therapy and peptide-based vaccines. Another challenging approach is microRNA-based therapy that involves two strategies. The first aims to inhibit oncogenic miRNAs by using miRNA antagonists and the second strategy is miRNA replacement, which involves the reintroduction of a tumor-suppressor miRNA mimetic to restore a loss of function.

Keywords: hepatocellular carcinoma, drug resistance, multimodal treatment, chemotherapy
 

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