Developments in predictive biomarkers for hepatocellular carcinoma therapy

ABSTRACT

Introduction: Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver and the third largest cause of cancer-relateddeaths worldwide. Potentially curative treatments (surgical resection, radiofrequency or liver transplantation) are only available for few patients, while transarterial chemoembolization (TACE) or systemic agents are the best treatments for intermediate and advanced stage disease. The identification of markers that allow us to choose the best treatment for the patient is urgent.

Areas covered: In this review we summarize the potential biological markers to predict the efficacy of all treatment available in patients with HCC and discuss anew biomarker with ahigher potential of success in the next future.

Expert opinion: HCC is aheterogeneous disease. Tumors are heterogeneous in terms of genetic alteration,with spatial heterogeneity in cellular density, necrosis and angiogenesis.This heterogeneity may affect prognosis and treatment. Tumor heterogeneity can be difficult to quantify with traditional imaging due to subjective assessment of images; the same for sampling biopsy, which evaluates only asmall part of the tumor. We think that combining multi-OMICSwith radiomics represents apromising strategy for evaluating tumor heterogenicity and for identifying biomarkers of response and prognosis.

KEYWORDS:

• Hepatocellular Carcinoma
• Biomarkers
• α-fetoprotein
• Sorafenib
• Immune checkpoints inhibitors
• Liquid biopsy
• Radiomics

ARTICLE HIGHLIGHTS

• HCC is a complex and multifaceted disease, with a poor prognosis in the advanced stage

• Sorafenib has been the only drug approved for the treatment of patients with advanced HCC for many years, but the treatment landscape is rapidly expanding

• Many biological markers have been evaluated in order to predict the efficacy of all treatment available, but at present, there is not a single biomarker allowing us to define the best treatment for each specific patient

• Other potential new biomarkers are under exploration, as the so-called OMICS revolution, Radiomics, Liquid Biopsy

• In this context, combining multi-OMICS with radiomics could represent a promising and ground-breaking strategy

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.