Anti-angiogenics in hepatocellular cancer therapy

Hepatocellular carcinoma (HCC) is one of the most common and deadly malignancies worldwide. HCC is a highly vascularized malignant tumor providing a rationale to consider angiogenesis as a therapeutic target. Anti-angiogenic strategies include locoregional and systemic treatments in HCC. Depending on the stage of the disease, different anti-angiogenic approaches are currently being employed in the treatment of HCC. For patients at intermediate stage disease, transarterial chemoembolization (TACE) has been widely accepted as the standard of care and is the most common therapy for this patient group. TACE is a locoregional intervention, and its main mechanism of action is the embolization of the tumor-feeding arteries. For patients with advanced HCC, the multiprotein kinase inhibitors sorafenib and regorafenib provide systemic treatment options. Their efficacy in terms of survival prolongation has been shown in the palliative setting. Both drugs target among others the receptor of the vascular endothelial growth factor (VEGF), and their antitumor efficacy is believed to partly depend on the anti-angiogenic properties.