Which medications in the drug class Antineoplastics, VEGF Inhibitor are used in the treatment of Hepatocellular Carcinoma (HCC)?

Answer

Antineoplastics, VEGF Inhibitor

Inhibits the kinase activities of various subtypes of vascular endothelial growth factor (VEGF) receptors.

Lenvatinib (Lenvima)

Lenvatinib is a receptor tyrosine kinase (RTK) inhibitor that inhibits the kinase activities of VEGFR1 (FLT1), VEGFR2 (KDR), and VEGFR3 (FLT4). It also inhibits other RTKs that have been implicated in pathogenic angiogenesis, tumor growth, and cancer progression in addition to their normal cellular functions, including fibroblast growth factor (FGF) receptors FGFR1, 2, 3, and 4; the platelet-derived growth factor receptor alpha (PDGFR-α); KIT; and RET. It is indicated for first-line treatment of unresectable HCC.

Ramucirumab (Cyramza)

Vascular endothelial growth factor receptor 2 (VEGFR2) antagonist that specifically binds VEGF receptor 2 and blocks binding of VEGFR ligands, VEGF-A, VEGF-C, and VEGF-D. As a result, ramucirumab inhibits ligand-stimulated activation of VEGF2, thereby inhibiting ligand-induced proliferation, and migration of human endothelial cells. It is indicated as monotherapy for hepatocellular carcinoma (HCC) in patients with alpha fetoprotein (AFP) of 400 ng/mL or higher who have been previously treated with sorafenib.

Bevacizumab (Avastin, Bevacizumab-awwb, Mvasi)

Recombinant humanized monoclonal antibody to VEGF. It blocks the angiogenic molecule VEGF thereby inhibiting tumor angiogenesis, starving tumor of blood and nutrients. It is indicated, in combination with atezolizumab, for unresectable or metastatic HCC who have not received prior systemic therapy.

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

International Agency for Research on Cancer. Liver. World Health Organization. Available at https://gco.iarc.fr/today/data/factsheets/cancers/11-Liver-fact-sheet.pdf. 2020; Accessed: January 30, 2021.
Kim HS, El-Serag HB. The Epidemiology of Hepatocellular Carcinoma in the USA. Curr Gastroenterol Rep. 2019 Apr 11. 21 (4):17. [Medline].
Petrick JL, McGlynn KA. The changing epidemiology of primary liver cancer. Curr Epidemiol Rep. 2019 Jun. 6 (2):104-111. [Medline].
[Guideline] Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018 Aug. 68 (2):723-750. [Medline]. [Full Text].
Elwood D, Pomposelli JJ. Hepatobiliary surgery: lessons learned from live donor hepatectomy. Surg Clin North Am. 2006 Oct. 86(5):1207-17, vii. [Medline].
Skandalakis JE, Skandalakis LJ, Skandalakis PN, Mirilas P. Hepatic surgical anatomy. Surg Clin North Am. 2004 Apr. 84 (2):413-35, viii. [Medline].
Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg. 1982 Jan. 6(1):3-9. [Medline].
Strasberg SM. Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg. 2005. 12(5):351-5. [Medline].
Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22 707 men in Taiwan. Lancet. 1981 Nov 21. 2 (8256):1129-33. [Medline].
Zhang X, Zhang H, Ye L. Effects of hepatitis B virus X protein on the development of liver cancer. J Lab Clin Med. 2006 Feb. 147(2):58-66. [Medline].
An P, Xu J, Yu Y, Winkler CA. Host and Viral Genetic Variation in HBV-Related Hepatocellular Carcinoma. Front Genet. 2018. 9:261. [Medline]. [Full Text].
Lee JS. The mutational landscape of hepatocellular carcinoma. Clin Mol Hepatol. 2015 Sep. 21 (3):220-9. [Medline]. [Full Text].
Li M, Zhao H, Zhang X, Wood LD, Anders RA, Choti MA, et al. Inactivating mutations of the chromatin remodeling gene ARID2 in hepatocellular carcinoma. Nat Genet. 2011 Aug 7. 43 (9):828-9. [Medline]. [Full Text].
Cameron RG, Greig PD, Farber E, Wilson S, Sherman M, Levy GA, et al. Small encapsulated hepatocellular carcinoma of the liver. Provisional analysis of pathogenetic mechanisms. Cancer. 1993 Nov 1. 72 (9):2550-9. [Medline].
Alison MR. Liver stem cells: implications for hepatocarcinogenesis. Stem Cell Rev. 2005. 1(3):253-60. [Medline].
Bamia C, Stuver S, Mucci L. Cancer of the Liver and Biliary Tract. Adami HO, Hunter DJ, Lagiou P, Mucci L, eds. In: Textbook of Cancer Epidemiology. 3rd ed. New York, NY: Oxford University Press; 2018. 277-308.
Fong Y, Dupuy DE, Feng M, Abou-Alfa G. Cancer of the Liver. DeVita VT Jr, Lawrence TS, Rosenberg SA, eds. In: DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia PA: Wolters Kluwer; 2018.
Bugianesi E. Non-alcoholic steatohepatitis and cancer. Clin Liver Dis. 2007 Feb. 11 (1):191-207, x-xi. [Medline].
El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology. 2004 Feb. 126(2):460-8. [Medline].
Davila JA, Morgan RO, Shaib Y, McGlynn KA, El-Serag HB. Diabetes increases the risk of hepatocellular carcinoma in the United States: a population based case control study. Gut. 2005 Apr. 54 (4):533-9. [Medline]. [Full Text].
McKillop IH, Moran DM, Jin X, Koniaris LG. Molecular pathogenesis of hepatocellular carcinoma. J Surg Res. 2006 Nov. 136 (1):125-35. [Medline].
Hester D, Golabi P, Paik J, Younossi I, Mishra A, Younossi ZM. Among Medicare Patients With Hepatocellular Carcinoma, Non-alcoholic Fatty Liver Disease is the Most Common Etiology and Cause of Mortality. J Clin Gastroenterol. 2019 Jan 21. [Medline].
Global Viral Hepatitis: Millions of People are Affected. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/hepatitis/global/index.htm. July 31, 2020; Accessed: January 30, 2021.
Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med. 1997 Jun 26. 336 (26):1855-9. [Medline].
Immunization Coverage. World Health Organization. Available at https://www.who.int/news-room/fact-sheets/detail/immunization-coverage. December 5, 2019; Accessed: March 2, 2020.
Trinchet JC, Ganne-Carrié N, Nahon P, N'kontchou G, Beaugrand M. Hepatocellular carcinoma in patients with hepatitis C virus-related chronic liver disease. World J Gastroenterol. 2007 May 7. 13 (17):2455-60. [Medline].
Cancer Facts & Figures 2021. American Cancer Society. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf. Accessed: January 30, 2021.
Cancer Stat Facts: Liver and Intrahepatic Bile Duct Cancer. Surveillance, Epidemiology, and End Results Program. Available at https://seer.cancer.gov/statfacts/html/livibd.html. Accessed: January 30, 2021.
Liu Z, Suo C, Mao X, Jiang Y, Jin L, Zhang T, et al. Global incidence trends in primary liver cancer by age at diagnosis, sex, region, and etiology, 1990-2017. Cancer. 2020 Mar 23. [Medline].
Harrison, P. Liver Cancer Increase Driven Mainly by NASH in Men Over 60. Medscape Medical News. March 23, 2020. Available at https://www.medscape.com/viewarticle/927374.
Davenport, L. Liver Cancer Rates Tripled Over 20 Years in England. Medscape News UK. November 5, 2019. Available at https://www.medscape.com/viewarticle/920826#vp_2.
Bertuccio P, Turati F, Carioli G, Rodriguez T, La Vecchia C, Malvezzi M, et al. Global trends and predictions in hepatocellular carcinoma mortality. J Hepatol. 2017 Aug. 67 (2):302-309. [Medline].
Kaneda K, Uenishi T, Takemura S, Shinkawa H, Urata Y, Sakae M, et al. The influence of postoperative glycemic control on recurrence after curative resection in diabetics with hepatitis C virus-related hepatocellular carcinoma. J Surg Oncol. 2012 May. 105 (6):606-11. [Medline].
Bosch FX, Ribes J, Díaz M, Cléries R. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004 Nov. 127 (5 Suppl 1):S5-S16. [Medline].
Peng SY, Chen WJ, Lai PL, Jeng YM, Sheu JC, Hsu HC. High alpha-fetoprotein level correlates with high stage, early recurrence and poor prognosis of hepatocellular carcinoma: significance of hepatitis virus infection, age, p53 and beta-catenin mutations. Int J Cancer. 2004 Oct 20. 112 (1):44-50. [Medline].
Colli A, Fraquelli M, Casazza G, Massironi S, Colucci A, Conte D, et al. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol. 2006 Mar. 101 (3):513-23. [Medline].
Arguedas MR, Chen VK, Eloubeidi MA, Fallon MB. Screening for hepatocellular carcinoma in patients with hepatitis C cirrhosis: a cost-utility analysis. Am J Gastroenterol. 2003 Mar. 98 (3):679-90. [Medline].
Llovet JM, Fuster J, Bruix J, Barcelona-Clínic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. 2004 Feb. 10 (2 Suppl 1):S115-20. [Medline].
Kim WR. The use of decision analytic models to inform clinical decision making in the management of hepatocellular carcinoma. Clin Liver Dis. 2005 May. 9(2):225-34. [Medline].
van Leeuwen DJ, Shumate CR. Space-occupying lesions of the liver. van Leeuwen DJ, Reeders JWAJ, Ariyama J, eds. Imaging in Hepatobiliary and Pancreatic Disease: A Practical Clinical Approach. London: WB Saunders; 2000.
Kemmer N, Neff G, Kaiser T, Zacharias V, Thomas M, Tevar A, et al. An analysis of the UNOS liver transplant registry: high serum alpha-fetoprotein does not justify an increase in MELD points for suspected hepatocellular carcinoma. Liver Transpl. 2006 Oct. 12 (10):1519-22. [Medline].
Saffroy R, Pham P, Reffas M, Takka M, Lemoine A, Debuire B. New perspectives and strategy research biomarkers for hepatocellular carcinoma. Clin Chem Lab Med. 2007. 45 (9):1169-79. [Medline].
Lencioni R, Cioni D, Della Pina C, Crocetti L, Bartolozzi C. Imaging diagnosis. Semin Liver Dis. 2005. 25 (2):162-70. [Medline].
Kulik LM, Mulcahy MF, Omary RA, Salem R. Emerging approaches in hepatocellular carcinoma. J Clin Gastroenterol. 2007 Oct. 41 (9):839-54. [Medline].
Broelsch CE, Frilling A, Malago M. Hepatoma--resection or transplantation. Surg Clin North Am. 2004 Apr. 84(2):495-511, x. [Medline].
Nguyen T, Phillips D, Jain D, Torbenson M, Wu TT, Yeh MM, et al. Comparison of 5 Immunohistochemical Markers of Hepatocellular Differentiation for the Diagnosis of Hepatocellular Carcinoma. Arch Pathol Lab Med. 2015 Aug. 139 (8):1028-34. [Medline].
Pawlik TM, Delman KA, Vauthey JN, et al. Tumor size predicts vascular invasion and histologic grade: Implications for selection of surgical treatment for hepatocellular carcinoma. Liver Transpl. 2005 Sep. 11(9):1086-92. [Medline].
Marrero JA, Fontana RJ, Barrat A, et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology. 2005 Apr. 41(4):707-16. [Medline].
[Guideline] NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. National Comprehensive Cancer Network. Available at https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf. Version 4.2019 — December 20, 2019; Accessed: March 2, 2020.
Rougier P, Mitry E, Barbare JC, Taieb J. Hepatocellular carcinoma (HCC): an update. Semin Oncol. 2007 Apr. 34 (2 Suppl 1):S12-20. [Medline].
Kaido T, Mori A, Ogura Y, Hata K, Yoshizawa A, Iida T, et al. Living donor liver transplantation for recurrent hepatocellular carcinoma after liver resection. Surgery. 2012 Jan. 151 (1):55-60. [Medline].
Cormier JN, Thomas KT, Chari RS, et al. Management of hepatocellular carcinoma. J Gastrointest Surg. 2006 May. 10(5):761-80. [Medline].
Marelli L, Stigliano R, Triantos C, et al. Treatment outcomes for hepatocellular carcinoma using chemoembolization in combination with other therapies. Cancer Treat Rev. 2006 Dec. 32(8):594-606. [Medline].
Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003 Feb. 37(2):429-42. [Medline].
Llovet JM. Updated treatment approach to hepatocellular carcinoma. J Gastroenterol. 2005 Mar. 40(3):225-35. [Medline].
Kudo M, et al; TACTICS study group. Randomised, multicentre prospective trial of transarterial chemoembolisation (TACE) plus sorafenib as compared with TACE alone in patients with hepatocellular carcinoma: TACTICS trial. Gut. 2019 Dec 4. [Medline]. [Full Text].
Mathurin P, Raynard B, Dharancy S, et al. Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther. 2003 May 15. 17(10):1247-61. [Medline].
Salem R, Hunter RD. Yttrium-90 microspheres for the treatment of hepatocellular carcinoma: a review. Int J Radiat Oncol Biol Phys. 2006. 66(2 Suppl):S83-8. [Medline].
Thomas MB, Zhu AX. Hepatocellular carcinoma: the need for progress. J Clin Oncol. 2005 May 1. 23 (13):2892-9. [Medline].
Zaanan A, Williet N, Hebbar M, Dabakuyo TS, Fartoux L, Mansourbakht T, et al. Gemcitabine plus oxaliplatin in advanced hepatocellular carcinoma: a large multicenter AGEO study. J Hepatol. 2013 Jan. 58 (1):81-8. [Medline].
Zhu AX. Systemic therapy of advanced hepatocellular carcinoma: how hopeful should we be?. Oncologist. 2006 Jul-Aug. 11(7):790-800. [Medline].
Abou-Alfa GK, Schwartz L, Ricci S, et al. Phase II study of sorafenib in patients with advanced hepatocellular carcinoma. J Clin Oncol. 2006 Sep 10. 24(26):4293-300. [Medline].
Liu L, Cao Y, Chen C, et al. Sorafenib blocks the RAF/MEK/ERK pathway, inhibits tumor angiogenesis, and induces tumor cell apoptosis in hepatocellular carcinoma model PLC/PRF/5. Cancer Res. 2006 Dec 15. 66(24):11851-8. [Medline].
Llovet JM, Ricci S, Mazzaferro V, et al, SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008 Jul 24. 359 (4):378-90. [Medline]. [Full Text].
King J, Palmer DH, Johnson P, Ross P, Hubner RA, Sumpter K, et al. Sorafenib for the Treatment of Advanced Hepatocellular Cancer - a UK Audit. Clin Oncol (R Coll Radiol). 2017 Apr. 29 (4):256-262. [Medline].
Keating GM. Sorafenib: A Review in Hepatocellular Carcinoma. Target Oncol. 2017 Apr. 12 (2):243-253. [Medline].
Bruix J, Qin S, Merle P, Granito A, Huang YH, Bodoky G, et al. Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017 Jan 7. 389 (10064):56-66. [Medline].
El-Khoueiry AB, Sangro B, Yau T, Crocenzi TS, Kudo M, Hsu C, et al. Nivolumab in patients with advanced hepatocellular carcinoma (CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Lancet. 2017 Jun 24. 389 (10088):2492-2502. [Medline].
Kudo M, Finn RS, Qin S, Han KH, Ikeda K, Piscaglia F, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018 Mar 24. 391 (10126):1163-1173. [Medline].
Zhu AX, Finn RS, Edeline J, Cattan S, Ogasawara S, Palmer D, et al. Pembrolizumab in patients with advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised, open-label phase 2 trial. Lancet Oncol. 2018 Jul. 19 (7):940-952. [Medline].
Abou-Alfa GK, Meyer T, Cheng AL, El-Khoueiry AB, Rimassa L, Ryoo BY, et al. Cabozantinib in Patients with Advanced and Progressing Hepatocellular Carcinoma. N Engl J Med. 2018 Jul 5. 379 (1):54-63. [Medline]. [Full Text].
Zhu AX, Kang YK, Yen CJ, et, for the, REACH-2 study investigators. Ramucirumab after sorafenib in patients with advanced hepatocellular carcinoma and increased α-fetoprotein concentrations (REACH-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019 Feb. 20 (2):282-296. [Medline].
Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, Kim TY, et al. Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med. 2020 May 14. 382 (20):1894-1905. [Medline].
FDA approves atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma. U.S. Food & Drug Administration. Available at https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-atezolizumab-plus-bevacizumab-unresectable-hepatocellular-carcinoma. June 1, 2020; Accessed: June 5, 2020.
Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, et al. Avatrombopag Before Procedures Reduces Need for Platelet Transfusion in Patients With Chronic Liver Disease and Thrombocytopenia. Gastroenterology. 2018 Sep. 155 (3):705-718. [Medline]. [Full Text].
Forner A, Hessheimer AJ, Isabel Real M, et al. Treatment of hepatocellular carcinoma. Crit Rev Oncol Hematol. 2006 Nov. 60(2):89-98. [Medline].
Mathurin P, Raynard B, Dharancy S, et al. Meta-analysis: evaluation of adjuvant therapy after curative liver resection for hepatocellular carcinoma. Aliment Pharmacol Ther. 2003 May 15. 17(10):1247-61. [Medline].
Sugimachi K, Maehara S, Tanaka S, et al. Repeat hepatectomy is the most useful treatment for recurrent hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2001. 8(5):410-6. [Medline].
Roayaie S, Obeidat K, Sposito C, Mariani L, Bhoori S, Pellegrinelli A, et al. Resection of hepatocellular cancer ≤2 cm: results from two Western centers. Hepatology. 2013 Apr. 57 (4):1426-35. [Medline].
Busuttil RW, Farmer DG. The surgical treatment of primary hepatobiliary malignancy. Liver Transpl Surg. 1996 Sep. 2(5 Suppl 1):114-30. [Medline].
Penn I. Hepatic transplantation for primary and metastatic cancers of the liver. Surgery. 1991 Oct. 110(4):726-34; discussion 734-5. [Medline].
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996 Mar 14. 334 (11):693-9. [Medline].
Bismuth H, Majno PE, Adam R. Liver transplantation for hepatocellular carcinoma. Semin Liver Dis. 1999. 19(3):311-22. [Medline].
Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology. 1999 Dec. 30(6):1434-40. [Medline].
Jonas S, Herrmann M, Rayes N, Berg T, Radke C, Tullius S, et al. Survival after liver transplantation for hepatocellular carcinoma in cirrhosis according to the underlying liver disease. Transplant Proc. 2001 Nov-Dec. 33 (7-8):3444-5. [Medline].
Philosophe B, Greig PD, Hemming AW, Cattral MS, Wanless I, Rasul I, et al. Surgical management of hepatocellular carcinoma: resection or transplantation?. J Gastrointest Surg. 1998 Jan-Feb. 2 (1):21-7. [Medline].
Molmenti EP, Klintmalm GB. Liver transplantation in association with hepatocellular carcinoma: an update of the International Tumor Registry. Liver Transpl. 2002 Sep. 8(9):736-48. [Medline].
Testa G, Crippin JS, Netto GJ, Goldstein RM, Jennings LW, Brkic BS, et al. Liver transplantation for hepatitis C: recurrence and disease progression in 300 patients. Liver Transpl. 2000 Sep. 6 (5):553-61. [Medline].
Yao FY, Bass NM, Nikolai B, Davern TJ, Kerlan R, Wu V, et al. Liver transplantation for hepatocellular carcinoma: analysis of survival according to the intention-to-treat principle and dropout from the waiting list. Liver Transpl. 2002 Oct. 8 (10):873-83. [Medline].
Freeman RB Jr. Transplantation for hepatocellular carcinoma: The Milan criteria and beyond. Liver Transpl. 2006 Nov. 12(11 Suppl 2):S8-13. [Medline].
Llovet JM, Vilana R, Brú C, Bianchi L, Salmeron JM, Boix L, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001 May. 33 (5):1124-9. [Medline].
Lencioni R, Crocetti L. A critical appraisal of the literature on local ablative therapies for hepatocellular carcinoma. Clin Liver Dis. 2005 May. 9(2):301-14, viii. [Medline].
Lencioni R, Goletti O, Armillotta N, Paolicchi A, Moretti M, Cioni D, et al. Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial. Eur Radiol. 1998. 8 (7):1205-11. [Medline].
Martin AP, Goldstein RM, Dempster J, Netto GJ, Katabi N, Derrick HC, et al. Radiofrequency thermal ablation of hepatocellular carcinoma before liver transplantation--a clinical and histological examination. Clin Transplant. 2006 Nov-Dec. 20 (6):695-705. [Medline].
Sawada N, Inoue M, Iwasaki M, Sasazuki S, Shimazu T, Yamaji T, et al. Consumption of n-3 fatty acids and fish reduces risk of hepatocellular carcinoma. Gastroenterology. 2012 Jun. 142 (7):1468-75. [Medline].
Lok AS, Everhart JE, Wright EC, Di Bisceglie AM, Kim HY, Sterling RK, et al. Maintenance peginterferon therapy and other factors associated with hepatocellular carcinoma in patients with advanced hepatitis C. Gastroenterology. 2011 Mar. 140(3):840-9; quiz e12. [Medline]. [Full Text].
Centers for Disease Control and Prevention. Viral Hepatitis. CDC.gov. Available at https://www.cdc.gov/hepatitis/populations/index.htm.. May 11, 2017; Accessed: March 28, 2020.
Jenkins, K. Liver Cancer Risk Reduced by Aspirin in Chronic Viral Hepatitis. Medscape Medical News. March 13, 2020. Available at https://www.medscape.com/viewarticle/926795.
Simon TG, Duberg AS, Aleman S, Chung RT, Chan AT, Ludvigsson JF. Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality. N Engl J Med. 2020 Mar 12. 382 (11):1018-1028. [Medline].
Kim RD, Reed AI, Fujita S, Foley DP, Mekeel KL, Hemming AW. Consensus and controversy in the management of hepatocellular carcinoma. J Am Coll Surg. 2007 Jul. 205 (1):108-23. [Medline].
Roayaie S, Schwartz JD, Sung MW, Emre SH, Miller CM, Gondolesi GE, et al. Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl. 2004 Apr. 10 (4):534-40. [Medline].
Portolani N, Coniglio A, Ghidoni S, Giovanelli M, Benetti A, Tiberio GA, et al. Early and late recurrence after liver resection for hepatocellular carcinoma: prognostic and therapeutic implications. Ann Surg. 2006 Feb. 243 (2):229-35. [Medline].
Hytiroglou P, Theise ND, Schwartz M, Mor E, Miller C, Thung SN. Macroregenerative nodules in a series of adult cirrhotic liver explants: issues of classification and nomenclature. Hepatology. 1995 Mar. 21 (3):703-8. [Medline].
[Guideline] Vogel A, Cervantes A, Chau I, Daniele B, Llovet J, Meyer T, et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1. 29 (Suppl 4):iv238-iv255. [Medline]. [Full Text].
[Guideline] Fetzer DT, Rodgers SK, Harris AC, Kono Y, Wasnik AP, Kamaya A, et al. Screening and Surveillance of Hepatocellular Carcinoma: An Introduction to Ultrasound Liver Imaging Reporting and Data System. Radiol Clin North Am. 2017 Nov. 55 (6):1197-1209. [Medline].
[Guideline] Marrero JA, Ahn J, Rajender Reddy K, Americal College of Gastroenterology. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014 Sep. 109 (9):1328-47; quiz 1348. [Medline].
El-Serag HB. Hepatocellular carcinoma: recent trends in the United States. Gastroenterology. 2004 Nov. 127(5 Suppl 1):S27-34. [Medline].
Chang MH, Chen TH, Hsu HM, Wu TC, Kong MS, Liang DC, et al. Prevention of hepatocellular carcinoma by universal vaccination against hepatitis B virus: the effect and problems. Clin Cancer Res. 2005 Nov 1. 11 (21):7953-7. [Medline].

Media Gallery

Large hepatocellular carcinoma. Image courtesy of Arief Suriawinata, MD, Department of Pathology, Dartmouth Medical School.
Photomicrograph of a liver demonstrating hepatocellular carcinoma. Image courtesy of Arief Suriawinata, MD, Department of Pathology, Dartmouth Medical School.
MRI of a liver with hepatocellular carcinoma.
Ultrasonographic image of hepatocellular carcinoma.
Arterial phase CT scan demonstrating enhancement of hepatocellular carcinoma.
Portal venous phase CT scan demonstrating washout of hepatocellular carcinoma.
The Barcelona-Clinic Liver Cancer (BCLC) approach to hepatocellular carcinoma management. Adapted from Llovet JM, Fuster J, Bruix J, Barcelona-Clinic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl. Feb 2004;10(2 Suppl 1):S115-20.
Hepatocellular carcinoma: pathobiology.
Right hepatectomy. Part 1: Dissection of portal vein. Courtesy of Memorial Sloan-Kettering Cancer Center, featuring Leslie H. Blumgart, MD. (From Blumgart LH. Video Atlas: Liver, Biliary & Pancreatic Surgery. Philadelphia, PA: Saunders; 2010.)
Right hepatectomy. Part 2: Devascularization of right liver. Courtesy of Memorial Sloan-Kettering Cancer Center, featuring Leslie H. Blumgart, MD. (From Blumgart LH. Video Atlas: Liver, Biliary & Pancreatic Surgery. Philadelphia, PA: Saunders; 2010.)
Right hepatectomy. Part 3: Suturing and dividing. Courtesy of Memorial Sloan-Kettering Cancer Center, featuring Leslie H. Blumgart, MD. (From Blumgart LH. Video Atlas: Liver, Biliary & Pancreatic Surgery. Philadelphia, PA: Saunders; 2010.)
Hepatocellular carcinoma (HCC). Dilated collateral superficial abdominal veins in a 67-year-old man with cirrhosis, HCC, and portal vein occlusion.
Hepatocellular carcinoma. Plain radiograph immediately following chemoembolization, demonstrating catheter placement and Ethiodol enhancement of tumors.

of 15

Author

Luca Cicalese, MD, FACS Professor of Surgery, John Sealy Distinguished Chair in Transplantation Surgery, Director, Texas Transplant Center and Hepatobiliary Surgery, Department of Surgery, University of Texas Medical Branch School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Additional Contributors

Burt Cagir, MD, FACS Clinical Professor of Surgery, Geisinger Commonwealth School of Medicine; Director, General Surgery Residency Program, Guthrie Robert Packer Hospital; Attending Surgeon, Guthrie Robert Packer Hospital and Corning Hospital

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, Association of Program Directors in Surgery, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Acknowledgements

David A Axelrod, MD, MBA Assistant Professor of Surgery, Section Chief, Solid Organ Transplantation, Dartmouth-Hitchcock Medical Center

David A Axelrod, MD, MBA is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, and New Hampshire Medical Society

Disclosure: Nothing to disclose.

Dirk J van Leeuwen, MD, PhD Professor of Medicine, Dartmouth Medical School; Consulting Staff, Director of Hepatology, Associate Director, Hepatopancreatico-biliary Center, Dartmouth-Hitchcock Medical Center; Consulting Gastroenterologist, White River Junction Veterans Administration Medical Center

Dirk J van Leeuwen, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, Dutch Society of Gastroenterology/Enterology, Dutch Society of Hepatology, European Association for the Study of the Liver, and New Hampshire Medical Society

Disclosure: Nothing to disclose.

Which medications in the drug class Antineoplastics, VEGF Inhibitor are used in the treatment of Hepatocellular Carcinoma (HCC)?

Antineoplastics, VEGF Inhibitor

Lenvatinib (Lenvima)

Ramucirumab (Cyramza)

Bevacizumab (Avastin, Bevacizumab-awwb, Mvasi)

Related Questions:

References

Tables

Contributor Information and Disclosures