Antiviral therapy in the palliative setting of HCC (BCLC-B and -C)

التفاصيل البيبلوغرافية
العنوان: Antiviral therapy in the palliative setting of HCC (BCLC-B and -C)
المؤلفون: Maria Reig, Giuseppe Cabibbo
المساهمون: Reig M., Cabibbo G.
بيانات النشر: Elsevier B.V., 2021.
سنة النشر: 2021
مصطلحات موضوعية: 0301 basic medicine, medicine.medical_specialty, Cirrhosis, recurrence, Carcinoma, Hepatocellular, medicine.medical_treatment, Decision Making, Liver transplantation, Antiviral Agents, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Stage (cooking), HCC, Intensive care medicine, DAA, Neoplasm Staging, Antiviral Agent, Hepatology, business.industry, Liver Neoplasms, Palliative Care, Cancer, Hepatitis C, Chronic, medicine.disease, BCLC Stage, 030104 developmental biology, BCLC-D, liver function, Hepatocellular carcinoma, 030211 gastroenterology & hepatology, Liver function, business, Liver cancer, BCLC-B, BCLC-C, Human
الوصف: The potential impact of direct-acting antivirals (DAAs) in patients with Barcelona Clinic Liver Cancer (BCLC)-B/C stage hepatocellular carcinoma (HCC) is understudied. Patients with HCC have been systematically excluded from randomised controlled trials evaluating the effectiveness of DAAs. Thus, the benefits of DAAs in patients with HCC are less well defined. The presence of active HCC before the initiation of DAA treatment is reported to be a predictor of DAA failure, and studies in patients without HCC have demonstrated that improvements in cirrhosis complications were lower or absent after DAA failure. Even if viral eradication is achieved using DAAs, reversal of liver function impairment may take longer than the development of end-stage cancer status. Additionally, the impact of DAAs on HCC recurrence is still a controversial topic. Thus, the decision of whether to use DAAs should be made on a patient-by-patient basis, and each patient should be informed of all the potential risks and benefits associated with their usage. This document summarises the current data on the usage of DAAs in BCLC-B/C patients, discusses the concept of "the point of no return" in the setting of DAAs, and proposes tools for deciding the best option for each patient profile. If liver function improvement overlaps with symptomatic HCC progression, the benefits of DAAs could be minimised, worsened, or fully counterbalanced. If the BCLC stage is defined using only liver dysfunction, the decision to prioritise DAA treatment should be based on the option (or lack thereof) of liver transplantation and/or the HCC stage. We propose applying a shared decision-making approach, informing each patient of all the potential risks and benefits of the proposed medical intervention.
اللغة: English
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d6aa19c68e75f590c9f5a31546943360
https://hdl.handle.net/10447/544082
Rights: OPEN
رقم الانضمام: edsair.doi.dedup.....d6aa19c68e75f590c9f5a31546943360
قاعدة البيانات: OpenAIRE