Hepatocellular carcinoma medical therapy: Difference between revisions

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**Peretinoin<ref name="NakamuraShidoji1995">{{cite journal|last1=Nakamura|first1=N.|last2=Shidoji|first2=Y.|last3=Yamada|first3=Y.|last4=Hatakeyama|first4=H.|last5=Moriwaki|first5=H.|last6=Muto|first6=Y.|title=Induction of Apoptosis by Acyclic Retinoid in the Human Hepatoma-Derived Cell Line, HuH-7|journal=Biochemical and Biophysical Research Communications|volume=207|issue=1|year=1995|pages=382–388|issn=0006291X|doi=10.1006/bbrc.1995.1199}}</ref><ref name="pmid11983450">{{cite journal |vauthors=Yasuda I, Shiratori Y, Adachi S, Obora A, Takemura M, Okuno M, Shidoji Y, Seishima M, Muto Y, Moriwaki H |title=Acyclic retinoid induces partial differentiation, down-regulates telomerase reverse transcriptase mRNA expression and telomerase activity, and induces apoptosis in human hepatoma-derived cell lines |journal=J. Hepatol. |volume=36 |issue=5 |pages=660–71 |year=2002 |pmid=11983450 |doi= |url=}}</ref><ref name="pmid11983450">{{cite journal |vauthors=Yasuda I, Shiratori Y, Adachi S, Obora A, Takemura M, Okuno M, Shidoji Y, Seishima M, Muto Y, Moriwaki H |title=Acyclic retinoid induces partial differentiation, down-regulates telomerase reverse transcriptase mRNA expression and telomerase activity, and induces apoptosis in human hepatoma-derived cell lines |journal=J. Hepatol. |volume=36 |issue=5 |pages=660–71 |year=2002 |pmid=11983450 |doi= |url=}}</ref>
**Peretinoin<ref name="NakamuraShidoji1995">{{cite journal|last1=Nakamura|first1=N.|last2=Shidoji|first2=Y.|last3=Yamada|first3=Y.|last4=Hatakeyama|first4=H.|last5=Moriwaki|first5=H.|last6=Muto|first6=Y.|title=Induction of Apoptosis by Acyclic Retinoid in the Human Hepatoma-Derived Cell Line, HuH-7|journal=Biochemical and Biophysical Research Communications|volume=207|issue=1|year=1995|pages=382–388|issn=0006291X|doi=10.1006/bbrc.1995.1199}}</ref><ref name="pmid11983450">{{cite journal |vauthors=Yasuda I, Shiratori Y, Adachi S, Obora A, Takemura M, Okuno M, Shidoji Y, Seishima M, Muto Y, Moriwaki H |title=Acyclic retinoid induces partial differentiation, down-regulates telomerase reverse transcriptase mRNA expression and telomerase activity, and induces apoptosis in human hepatoma-derived cell lines |journal=J. Hepatol. |volume=36 |issue=5 |pages=660–71 |year=2002 |pmid=11983450 |doi= |url=}}</ref><ref name="pmid11983450">{{cite journal |vauthors=Yasuda I, Shiratori Y, Adachi S, Obora A, Takemura M, Okuno M, Shidoji Y, Seishima M, Muto Y, Moriwaki H |title=Acyclic retinoid induces partial differentiation, down-regulates telomerase reverse transcriptase mRNA expression and telomerase activity, and induces apoptosis in human hepatoma-derived cell lines |journal=J. Hepatol. |volume=36 |issue=5 |pages=660–71 |year=2002 |pmid=11983450 |doi= |url=}}</ref>
**Orantinib<ref name="pmid11779084">{{cite journal |vauthors=Hoekman K |title=SU6668, a multitargeted angiogenesis inhibitor |journal=Cancer J |volume=7 Suppl 3 |issue= |pages=S134–8 |year=2001 |pmid=11779084 |doi= |url=}}</ref><ref>Park JW, Cheng AL, Kudo M, Park JH, Liang CP, Hidaka H, et al: A randomized, double-blind, placebo-controlled phase III trial of TSU-68 (orantinib) combined with transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 2015;62(suppl 1):abstract G06</ref>
**Orantinib<ref name="pmid11779084">{{cite journal |vauthors=Hoekman K |title=SU6668, a multitargeted angiogenesis inhibitor |journal=Cancer J |volume=7 Suppl 3 |issue= |pages=S134–8 |year=2001 |pmid=11779084 |doi= |url=}}</ref><ref>Park JW, Cheng AL, Kudo M, Park JH, Liang CP, Hidaka H, et al: A randomized, double-blind, placebo-controlled phase III trial of TSU-68 (orantinib) combined with transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 2015;62(suppl 1):abstract G06</ref>
**Brivanib
**Brivanib<ref name="KudoHan2014">{{cite journal|last1=Kudo|first1=Masatoshi|last2=Han|first2=Guohong|last3=Finn|first3=Richard S.|last4=Poon|first4=Ronnie T.P.|last5=Blanc|first5=Jean-Frederic|last6=Yan|first6=Lunan|last7=Yang|first7=Jijin|last8=Lu|first8=Ligong|last9=Tak|first9=Won-Young|last10=Yu|first10=Xiaoping|last11=Lee|first11=Joon-Hyeok|last12=Lin|first12=Shi-Ming|last13=Wu|first13=Changping|last14=Tanwandee|first14=Tawesak|last15=Shao|first15=Guoliang|last16=Walters|first16=Ian B.|last17=Dela Cruz|first17=Christine|last18=Poulart|first18=Valerie|last19=Wang|first19=Jian-Hua|title=Brivanib as adjuvant therapy to transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized phase III trial|journal=Hepatology|volume=60|issue=5|year=2014|pages=1697–1707|issn=02709139|doi=10.1002/hep.27290}}</ref>
 


*First-Line Therapy for Advanced HCC:
*First-Line Therapy for Advanced HCC:
**[[Sunitinib]]
**[[Sunitinib]]<ref name="pmid12538485">{{cite journal |vauthors=Mendel DB, Laird AD, Xin X, Louie SG, Christensen JG, Li G, Schreck RE, Abrams TJ, Ngai TJ, Lee LB, Murray LJ, Carver J, Chan E, Moss KG, Haznedar JO, Sukbuntherng J, Blake RA, Sun L, Tang C, Miller T, Shirazian S, McMahon G, Cherrington JM |title=In vivo antitumor activity of SU11248, a novel tyrosine kinase inhibitor targeting vascular endothelial growth factor and platelet-derived growth factor receptors: determination of a pharmacokinetic/pharmacodynamic relationship |journal=Clin. Cancer Res. |volume=9 |issue=1 |pages=327–37 |year=2003 |pmid=12538485 |doi= |url=}}</ref><ref name="ChengKang2013">{{cite journal|last1=Cheng|first1=Ann-Lii|last2=Kang|first2=Yoon-Koo|last3=Lin|first3=Deng-Yn|last4=Park|first4=Joong-Won|last5=Kudo|first5=Masatoshi|last6=Qin|first6=Shukui|last7=Chung|first7=Hyun-Cheol|last8=Song|first8=Xiangqun|last9=Xu|first9=Jianming|last10=Poggi|first10=Guido|last11=Omata|first11=Masao|last12=Pitman Lowenthal|first12=Susan|last13=Lanzalone|first13=Silvana|last14=Yang|first14=Liqiang|last15=Lechuga|first15=Maria Jose|last16=Raymond|first16=Eric|title=Sunitinib Versus Sorafenib in Advanced Hepatocellular Cancer: Results of a Randomized Phase III Trial|journal=Journal of Clinical Oncology|volume=31|issue=32|year=2013|pages=4067–4075|issn=0732-183X|doi=10.1200/JCO.2012.45.8372}}</ref>
**Brivanib
**Brivanib<ref name="pmid23980084">{{cite journal |vauthors=Johnson PJ, Qin S, Park JW, Poon RT, Raoul JL, Philip PA, Hsu CH, Hu TH, Heo J, Xu J, Lu L, Chao Y, Boucher E, Han KH, Paik SW, Robles-Aviña J, Kudo M, Yan L, Sobhonslidsuk A, Komov D, Decaens T, Tak WY, Jeng LB, Liu D, Ezzeddine R, Walters I, Cheng AL |title=Brivanib versus sorafenib as first-line therapy in patients with unresectable, advanced hepatocellular carcinoma: results from the randomized phase III BRISK-FL study |journal=J. Clin. Oncol. |volume=31 |issue=28 |pages=3517–24 |year=2013 |pmid=23980084 |doi=10.1200/JCO.2012.48.4410 |url=}}</ref>
**Linifanib
**Linifanib<ref name="CainapQin2015">{{cite journal|last1=Cainap|first1=Calin|last2=Qin|first2=Shukui|last3=Huang|first3=Wen-Tsung|last4=Chung|first4=Ik Joo|last5=Pan|first5=Hongming|last6=Cheng|first6=Ying|last7=Kudo|first7=Masatoshi|last8=Kang|first8=Yoon-Koo|last9=Chen|first9=Pei-Jer|last10=Toh|first10=Han-Chong|last11=Gorbunova|first11=Vera|last12=Eskens|first12=Ferry A.L.M.|last13=Qian|first13=Jiang|last14=McKee|first14=Mark D.|last15=Ricker|first15=Justin L.|last16=Carlson|first16=Dawn M.|last17=El-Nowiem|first17=Saied|title=Linifanib Versus Sorafenib in Patients With Advanced Hepatocellular Carcinoma: Results of a Randomized Phase III Trial|journal=Journal of Clinical Oncology|volume=33|issue=2|year=2015|pages=172–179|issn=0732-183X|doi=10.1200/JCO.2013.54.3298}}</ref>
**[[Sorafenib]] plus [[Erlotinib]]
**[[Sorafenib]] plus [[Erlotinib]]<ref name="ZhuRosmorduc2015">{{cite journal|last1=Zhu|first1=Andrew X.|last2=Rosmorduc|first2=Olivier|last3=Evans|first3=T.R. Jeffry|last4=Ross|first4=Paul J.|last5=Santoro|first5=Armando|last6=Carrilho|first6=Flair Jose|last7=Bruix|first7=Jordi|last8=Qin|first8=Shukui|last9=Thuluvath|first9=Paul J.|last10=Llovet|first10=Josep M.|last11=Leberre|first11=Marie-Aude|last12=Jensen|first12=Markus|last13=Meinhardt|first13=Gerold|last14=Kang|first14=Yoon-Koo|title=SEARCH: A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial of Sorafenib Plus Erlotinib in Patients With Advanced Hepatocellular Carcinoma|journal=Journal of Clinical Oncology|volume=33|issue=6|year=2015|pages=559–566|issn=0732-183X|doi=10.1200/JCO.2013.53.7746}}</ref>
**[[Lenvatinib]]
**[[Lenvatinib]]<ref name="YamamotoMatsui2014">{{cite journal|last1=Yamamoto|first1=Yuji|last2=Matsui|first2=Junji|last3=Matsushima|first3=Tomohiro|last4=Obaishi|first4=Hiroshi|last5=Miyazaki|first5=Kazuki|last6=Nakamura|first6=Katsuji|last7=Tohyama|first7=Osamu|last8=Semba|first8=Taro|last9=Yamaguchi|first9=Atsumi|last10=Hoshi|first10=Sachi|last11=Mimura|first11=Fusayo|last12=Haneda|first12=Toru|last13=Fukuda|first13=Yoshio|last14=Kamata|first14=Jun-ichi|last15=Takahashi|first15=Keiko|last16=Matsukura|first16=Masayuki|last17=Wakabayashi|first17=Toshiaki|last18=Asada|first18=Makoto|last19=Nomoto|first19=Ken-ichi|last20=Watanabe|first20=Tatsuo|last21=Dezso|first21=Zoltan|last22=Yoshimatsu|first22=Kentaro|last23=Funahashi|first23=Yasuhiro|last24=Tsuruoka|first24=Akihiko|title=Lenvatinib, an angiogenesis inhibitor targeting VEGFR/FGFR, shows broad antitumor activity in human tumor xenograft models associated with microvessel density and pericyte coverage|journal=Vascular Cell|volume=6|issue=1|year=2014|pages=18|issn=2045-824X|doi=10.1186/2045-824X-6-18}}</ref><ref name="IkedaKudo2016">{{cite journal|last1=Ikeda|first1=Kenji|last2=Kudo|first2=Masatoshi|last3=Kawazoe|first3=Seiji|last4=Osaki|first4=Yukio|last5=Ikeda|first5=Masafumi|last6=Okusaka|first6=Takuji|last7=Tamai|first7=Toshiyuki|last8=Suzuki|first8=Takuya|last9=Hisai|first9=Takashi|last10=Hayato|first10=Seiichi|last11=Okita|first11=Kiwamu|last12=Kumada|first12=Hiromitsu|title=Phase 2 study of lenvatinib in patients with advanced hepatocellular carcinoma|journal=Journal of Gastroenterology|volume=52|issue=4|year=2016|pages=512–519|issn=0944-1174|doi=10.1007/s00535-016-1263-4}}</ref><ref>Kudo M, Finn R, Qin S, Han K-H, Ikeda K, Piscaglia F, Baron A, Park J-W, Han G, Jassem J, Blanc JF, Vogel A, Komov D, Evans TRJ, Lopez C, Dutcus C, Guo M, Saito K, Kraljevic S, Tamai T, Ren M, Cheng A-L: A randomised phase 3 trial of lenvatinib vs. sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma</ref>
**Intra-Arterial Radioembolization with [[90Y-DOTA-biotin|90Y]].[[90Y-DOTA-biotin|90Y]] radioembolization
 
**Intra-Arterial Radioembolization with [[90Y-DOTA-biotin|90Y]] radioembolization<ref name="KhajornjiraphanThu2015">{{cite journal|last1=Khajornjiraphan|first1=Natthida|last2=Thu|first2=Nyein Aye|last3=Chow|first3=Pierce Kah Hoe|title=Yttrium-90 Microspheres: A Review of Its Emerging Clinical Indications|journal=Liver Cancer|volume=4|issue=1|year=2015|pages=6–15|issn=2235-1795|doi=10.1159/000343876}}</ref><ref name="EdelineGilabert2015">{{cite journal|last1=Edeline|first1=Julien|last2=Gilabert|first2=Marine|last3=Garin|first3=Etienne|last4=Boucher|first4=Eveline|last5=Raoul|first5=Jean-Luc|title=Yttrium-90 Microsphere Radioembolization for Hepatocellular Carcinoma|journal=Liver Cancer|volume=4|issue=1|year=2015|pages=16–25|issn=2235-1795|doi=10.1159/000343878}}</ref>
**Hepatic Arterial Infusion Chemotherapy
**Hepatic Arterial Infusion Chemotherapy



Revision as of 13:23, 23 January 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [3]

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Overview

Patients with hepatocellular carcinoma are treated with sorafenib, ethanol injections, transcatheter arterial chemoembolization (TACE), sealed source radiotherapy, radiofrequency ablation (RFA), intra-arterial iodine-131-lipiodol administration, high intensity focused ultrasound (HIFU), hormonal therapy, and chemotherapy.

Medical Therapy

Medical therapy for hepatocellular carcinoma

Protein kinase inhibitors

Currently, Sorafenib has been approved as the sole management for systemic therapy of hepatocellular carcinoma in the advanced stages.[1][2] [3][4][5][6][7][8][9][10]

Molecular Targeted Agents for HCC


    • Intra-Arterial Radioembolization with 90Y radioembolization[24][25]
    • Hepatic Arterial Infusion Chemotherapy
  • Second-Line Therapy for Advanced HCC:

The standard management for advanced HCC is sorafenib

Percutaneous ethanol injection

  • Percutaneous ethanol injection (PEI) is best-known image-guided percutaneous ablation for hepatocellular carcinoma:[26][27][28][29][30][31][32]
    • It is well tolerated and is preferred in small (< 3 cm) solitary tumors.
    • It is an inexpensive procedure
    • It has few adverse effects
    • It can be repeated in patients with relapse
    • Survival is comparable with the patients who undergo surgical resection
    • Efficacy is comparable to radiofrequency ablation

Transcatheter arterial chemoembolization (TACE)

  • Transcatheter arterial chemoembolization is performed in the following conditions:[32][33][34][35][36][37][38][39]
  • Transcatheter arterial chemoembolization (TACE) is usually performed in the treatment of large tumors (larger than 3 cm and less than 4 cm in diameter), most frequently by intraarterially injecting an infusion of antineoplastic agents mixed with iodized oil (such as Lipiodol).
  • Combined PEI and TACE can be used for tumors larger than 4 cm in diameter.
  • TACE followed by sorafenib provides optimal results of progression-free survival and survival in patients with HCC who are non responsive to TACE.

Sealed source radiotherapy

  • Sealed source radiotherapy can be used to destroy the tumor from within (thus minimizing exposure to healthy tissue). TheraSphere is an FDA approved treatment which has been shown in clinical trials to increase survival rate of low-risk patients. This method uses a catheter (inserted by a radiologist) to deposit radioactive particles to the area of interest.[40]

Radiofrequency ablation (RFA)

Intra-arterial iodine-131–lipiodol administration

  • Intra-arterial iodine-131–lipiodol administration demonstrated some efficacy in unresectable tumors, especially in patients with portal vein thrombus. This treatment is also used as adjuvant therapy in resected patients. It is believed to raise the 3-year survival rate from 46 to 86%.

High intensity focused ultrasound (HIFU)

  • High intensity focused ultrasound (HIFU) is a new technique which uses much very powerful ultrasound to treat the tumour. Still at a very experimental stage. Most of the work has been done in China. Some early work is being done in Oxford and London in the UK.

Hormonal therapy

Chemotherapy

  • Oral synthetic retinoid for 12 months after resection/ablation maybe helpful in the treatment of hepatocellular carcinoma.[41]

Contraindicated medications

Hepatocellular carcinoma is considered an absolute contraindication to the use of the following medications:

Effectiveness of medical therapy

The effectiveness of medical therapy depends on the following:

  • Size
  • Involvement of liver vessels
  • Presence of a tumor capsule
  • Presence of extrahepatic metastases
  • Presence of daughter nodules
  • Vascularity of the tumor

References

  1. Howe CW (1968). "Experimental wound sepsis from transient bacteremia". Surg Gynecol Obstet. 126 (5): 1066–70. PMID 4870992.
  2. Zhang, Bingnan; Finn, Richard S. (2016). "Personalized Clinical Trials in Hepatocellular Carcinoma Based on Biomarker Selection". Liver Cancer. 5 (3): 221–232. doi:10.1159/000367763. ISSN 2235-1795.
  3. Wilhelm, Scott M.; Carter, Christopher; Tang, LiYa; Wilkie, Dean; McNabola, Angela; Rong, Hong; Chen, Charles; Zhang, Xiaomei; Vincent, Patrick; McHugh, Mark; Cao, Yichen; Shujath, Jaleel; Gawlak, Susan; Eveleigh, Deepa; Rowley, Bruce; Liu, Li; Adnane, Lila; Lynch, Mark; Auclair, Daniel; Taylor, Ian; Gedrich, Rich; Voznesensky, Andrei; Riedl, Bernd; Post, Leonard E.; Bollag, Gideon; Trail, Pamela A. (2004). "BAY 43-9006 Exhibits Broad Spectrum Oral Antitumor Activity and Targets the RAF/MEK/ERK Pathway and Receptor Tyrosine Kinases Involved in Tumor Progression and Angiogenesis". Cancer Research. 64 (19): 7099–7109. doi:10.1158/0008-5472.CAN-04-1443. ISSN 0008-5472.
  4. Chang, Yong S.; Adnane, Jalila; Trail, Pamela A.; Levy, Joan; Henderson, Arris; Xue, Dahai; Bortolon, Elizabeth; Ichetovkin, Marina; Chen, Charles; McNabola, Angela; Wilkie, Dean; Carter, Christopher A.; Taylor, Ian C. A.; Lynch, Mark; Wilhelm, Scott (2006). "Sorafenib (BAY 43-9006) inhibits tumor growth and vascularization and induces tumor apoptosis and hypoxia in RCC xenograft models". Cancer Chemotherapy and Pharmacology. 59 (5): 561–574. doi:10.1007/s00280-006-0393-4. ISSN 0344-5704.
  5. Llovet, Josep M.; Ricci, Sergio; Mazzaferro, Vincenzo; Hilgard, Philip; Gane, Edward; Blanc, Jean-Frédéric; de Oliveira, Andre Cosme; Santoro, Armando; Raoul, Jean-Luc; Forner, Alejandro; Schwartz, Myron; Porta, Camillo; Zeuzem, Stefan; Bolondi, Luigi; Greten, Tim F.; Galle, Peter R.; Seitz, Jean-François; Borbath, Ivan; Häussinger, Dieter; Giannaris, Tom; Shan, Minghua; Moscovici, Marius; Voliotis, Dimitris; Bruix, Jordi (2008). "Sorafenib in Advanced Hepatocellular Carcinoma". New England Journal of Medicine. 359 (4): 378–390. doi:10.1056/NEJMoa0708857. ISSN 0028-4793.
  6. Cheng, Ann-Lii; Kang, Yoon-Koo; Chen, Zhendong; Tsao, Chao-Jung; Qin, Shukui; Kim, Jun Suk; Luo, Rongcheng; Feng, Jifeng; Ye, Shenglong; Yang, Tsai-Sheng; Xu, Jianming; Sun, Yan; Liang, Houjie; Liu, Jiwei; Wang, Jiejun; Tak, Won Young; Pan, Hongming; Burock, Karin; Zou, Jessie; Voliotis, Dimitris; Guan, Zhongzhen (2009). "Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial". The Lancet Oncology. 10 (1): 25–34. doi:10.1016/S1470-2045(08)70285-7. ISSN 1470-2045.
  7. Kang, Tae Wook; Rhim, Hyunchul (2015). "Recent Advances in Tumor Ablation for Hepatocellular Carcinoma". Liver Cancer. 4 (3): 176–187. doi:10.1159/000367740. ISSN 2235-1795.
  8. Kudo, Masatoshi; Izumi, Namiki; Sakamoto, Michiie; Matsuyama, Yutaka; Ichida, Takafumi; Nakashima, Osamu; Matsui, Osamu; Ku, Yonson; Kokudo, Norihiro; Makuuchi, Masatoshi (2016). "Survival Analysis over 28 Years of 173,378 Patients with Hepatocellular Carcinoma in Japan". Liver Cancer. 5 (3): 190–197. doi:10.1159/000367775. ISSN 2235-1795.
  9. Okita, Kiwamu; Izumi, Namiki; Matsui, Osamu; Tanaka, Katsuaki; Kaneko, Shuichi; Moriwaki, Hisataka; Ikeda, Kenji; Osaki, Yukio; Numata, Kazushi; Nakachi, Kohei; Kokudo, Norihiro; Imanaka, Kazuho; Nishiguchi, Shuhei; Okusaka, Takuji; Nishigaki, Yoichi; Shiomi, Susumu; Kudo, Masatoshi; Ido, Kenichi; Karino, Yoshiyasu; Hayashi, Norio; Ohashi, Yasuo; Makuuchi, Masatoshi; Kumada, Hiromitsu (2014). "Peretinoin after curative therapy of hepatitis C-related hepatocellular carcinoma: a randomized double-blind placebo-controlled study". Journal of Gastroenterology. 50 (2): 191–202. doi:10.1007/s00535-014-0956-9. ISSN 0944-1174.
  10. 10.0 10.1 Hagiwara, Satoru; Nishida, Naoshi; Watanabe, Tomohiro; Sakurai, Toshiharu; Ida, Hiroshi; Minami, Yasunori; Takita, Masahiro; Minami, Tomohiro; Iwanishi, Mina; Chishina, Hirokazu; Ueshima, Kazuomi; Komeda, Yoriaki; Arizumi, Tadaaki; Kudo, Masatoshi (2016). "Outcome of Asunaprevir/Daclatasvir Combination Therapy for Chronic Liver Disease Type C". Digestive Diseases. 34 (6): 620–626. doi:10.1159/000448822. ISSN 0257-2753.
  11. Nakamura, N.; Shidoji, Y.; Yamada, Y.; Hatakeyama, H.; Moriwaki, H.; Muto, Y. (1995). "Induction of Apoptosis by Acyclic Retinoid in the Human Hepatoma-Derived Cell Line, HuH-7". Biochemical and Biophysical Research Communications. 207 (1): 382–388. doi:10.1006/bbrc.1995.1199. ISSN 0006-291X.
  12. 12.0 12.1 Yasuda I, Shiratori Y, Adachi S, Obora A, Takemura M, Okuno M, Shidoji Y, Seishima M, Muto Y, Moriwaki H (2002). "Acyclic retinoid induces partial differentiation, down-regulates telomerase reverse transcriptase mRNA expression and telomerase activity, and induces apoptosis in human hepatoma-derived cell lines". J. Hepatol. 36 (5): 660–71. PMID 11983450.
  13. Hoekman K (2001). "SU6668, a multitargeted angiogenesis inhibitor". Cancer J. 7 Suppl 3: S134–8. PMID 11779084.
  14. Park JW, Cheng AL, Kudo M, Park JH, Liang CP, Hidaka H, et al: A randomized, double-blind, placebo-controlled phase III trial of TSU-68 (orantinib) combined with transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma. J Hepatol 2015;62(suppl 1):abstract G06
  15. Kudo, Masatoshi; Han, Guohong; Finn, Richard S.; Poon, Ronnie T.P.; Blanc, Jean-Frederic; Yan, Lunan; Yang, Jijin; Lu, Ligong; Tak, Won-Young; Yu, Xiaoping; Lee, Joon-Hyeok; Lin, Shi-Ming; Wu, Changping; Tanwandee, Tawesak; Shao, Guoliang; Walters, Ian B.; Dela Cruz, Christine; Poulart, Valerie; Wang, Jian-Hua (2014). "Brivanib as adjuvant therapy to transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized phase III trial". Hepatology. 60 (5): 1697–1707. doi:10.1002/hep.27290. ISSN 0270-9139.
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