Clinical practice guidelines and real-life practice for hepatocellular carcinoma in Taiwan

Su, Tung-Hung; Wu, Chih-Horng; Liu, Tsung-Hao; Ho, Cheng-Maw; Liu, Chun-Jen

doi:.0.0.0

Review

Clinical practice guidelines and real-life practice for hepatocellular carcinoma in Taiwan

Tung-Hung Su^1,2, Chih-Horng Wu^2,3, Tsung-Hao Liu^4,5, Cheng-Maw Ho^2,6, Chun-Jen Liu^1,2,7

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
²Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
³Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
⁴Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
⁵Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
⁶Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
⁷Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

Correspondence :

Chun-Jen Liu ,
Email: cjliu@ntu.edu.tw

Received: November 26, 2023 Revised: January 12, 2023 Accepted: January 24, 2023

ABSTRACT

Hepatocellular carcinoma (HCC) is the fourth most common cancer and the second leading cause of cancer-related death in Taiwan. The Taiwan Liver Cancer Association and the Gastroenterological Society of Taiwan developed and updated the guidelines for HCC management in 2020. In clinical practice, we follow these guidelines and the reimbursement policy of the government. Abdominal ultrasonography, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II (PIVKA-II) tests are performed for HCC surveillance every 6 months, which may be shortened to 3 months for high-risk patients. Dynamic computed tomography, magnetic resonance imaging, and contrast-enhanced ultrasound can be recommended for HCC surveillance in patients with extremely high-risk or poor ultrasonographic visualization results. HCC is usually diagnosed through dynamic imaging, and pathological diagnosis is recommended. The staging of HCC is based on a modified version of the Barcelona Clinic Liver Cancer (BCLC) system, and the HCC management guidelines in Taiwan actively promote curative treatments, including surgery and locoregional therapy for BCLC-B-C patients. Su et al. 4 Transarterial chemoembolization (TACE), drug-eluting bead TACE, radioembolization, and hepatic artery infusion chemotherapy may be administered for patients with BCLC-B-C HCC. Sorafenib and lenvatinib are reimbursed as systemic therapies, and regorafenib and ramucirumab can be reimbursed in cases of sorafenib failure. First-line atezolizumab with bevacizumab are not yet reimbursed but may be administered in clinical practice. Chemotherapy and external beam radiation therapy may be used in specific patients. Early switching to systemic therapy in TACE-refractory patients is a recent paradigm shift in HCC management.

KeyWords: liver cancer, surveillance, Barcelona Clinic Liver Cancer, surgery, systemic therapy