Medical Treatment of Hepatocellular Carcinoma: Any Progress?

In the 1994 document, the authors concluded that medical treatments for hepatocellular carcinoma (HCC) at the time had not shown significant progress in improving patient survival. Systemic chemotherapy had response rates below 20% with a median survival of 2-6 months, and trials often suffered from methodological issues such as non-uniform response criteria and small patient numbers. Biological response modifiers (BRMs) and interferon treatments were not effective and had poor tolerance, with drug-related deaths in 4% of patients. Hormone therapy and interleukin-2 (IL-2) therapy also showed minimal success. Intra-arterial chemotherapy and chemoembolization had higher response rates in some studies, but no definitive advantage was established, and the complexity and cost of treatments were likely to limit their development. Percutaneous alcohol injection (PEI) showed promise for small HCCs with a 5-year survival rate of 44% for Child's A patients, but controlled trials were needed. Liver transplantation showed encouraging initial results, and new approaches like liposome-complex drug therapy and reversing drug resistance were being evaluated. Overall, the document emphasized the need for better-designed trials and new treatment modalities to improve outcomes for HCC patients.