Despite the significant therapeutic armamentarium existing for the treatment
of hepatocellular carcinoma (HCC), there is a spectacular lack of chemotherapeutic
agents. A noticeable exception is sorafenib, a multikinase inhibitor against Raf kinase.
Despite the attractiveness of the tumor antiangiogenic mechanism of sorafenib, it has
only gained acceptance in clinical use in cases of advanced HCC, as it has been shown
to increase survival by approximately 3 months. This comes at a significant financial
cost for the health care system, in addition to the potential adverse events for the
patient.
This chapter will explore the mechanism of action for sorafenib, including the potential
of antiangiogenic agents in the management of HCC. Additionally, the current
experience with its use will be analyzed, as well as the problems encountered with the
complications of the medication. More importantly, the ultimate goal of the paper is to
further explore the proposed use of sorafenib in different stages of the treatment
continuum, as it may hold more promise than currently thought. Specifically, there have
been thoughts and attempts to use the medication prior to a liver transplant, or following
a liver transplant or a hepatectomy, in an attempt to avoid recurrence. Several drugs are
under investigation in clinical trials after the failure of sorafenib, or in combination with
sorafenib. Looking into these questions may help identify its proper place in the
management of HCC, as well as its true potential.
Keywords: Advanced stage, complication, hepatocellular carcinoma, hepatic resection,
liver failure, multikinase inhibitor, orthotopic liver transplantation, rapamycin, signaling
pathways, sorafenib, targeted therapy, treatment, tumor angiogenesis.
