1).1,2 According to the report of the 18th follow-up survey, 3-, 5- and 10-year survival rates for TACE (including chemolipiodolization)

used to treat HCC were all poor, at 43.2%, 24.1% and 6.6%, respectively.9 These PLX-4720 datasheet outcomes are due to the inclusion of patients in poor condition with hepatic reserve or tumor stage that contraindicates hepatic resection or RFA. The same Japanese follow-up survey of outcomes for TACE as initial therapy for Child–Pugh class A patients with a single tumor found that 1-, 3- and 5-year survival rates were good, at 93%, 73% and 52%, respectively.35,38 Transcatheter arterial chemoembolization is performed as initial treatment in 31.7% of cases,9 but is the most frequently used treatment for recurrence, and it is no exaggeration to say that most HCC patients undergo this therapy at some point (Fig. 2). TACE is periodically repeated in Europe and the USA, but this situation rarely arises in Japan. selleck compound When one to three intrahepatic lesions are present, TACE is followed by additional RFA with the aim of improving local control. With the advent of sorafenib, definitions of TACE failure/refractory HCC have

now been proposed to prevent liver dysfunction from decreasing after excursively repeating TACE and to maintain opportunities to administrate sorafenib.1 SORAFENIB WAS APPROVED as a molecular-targeted drug for the treatment of HCC in Japan from May 2009. This agent was approved based on the results MCE公司 of two randomized control trials from outside of Japan39,40 and a phase I clinical trial carried out in Japan.41 However, studies continued after sorafenib entered the market due to a lack of experience with administration in Japan. A safety alert was initially issued due to early deaths resulting from liver failure and hepatic encephalopathy, but it has since been used correctly. The median survival period in Japan is 11.0 months and the response rate is 4%, almost the same outcomes as those of the SHARP trial, but reports to date have shown a tendency

for a greater number of side-effects, including hand–foot skin reaction, diarrhea, hypertension, loss of appetite and fatigue.42 Sorafenib is used to treat Child–Pugh class A patients who have extrahepatic lesions or multiple intrahepatic lesions who are unable to undergo TACE or HAIC, and patients with vascular invasion.1 Measures taken in Japan to reduce side-effects include a low initial dose of 400 mg/day,42 but drug effectiveness at half dose has yet to be fully investigated. Sorafenib has also not been compared with HAIC, which was already being performed in Japan, and there is debate on its positioning in the treatment of advanced intrahepatic cancer. A study is currently underway to verify the effects of combining sorafenib therapy and HAIC.