ading to inhibition of Ask 1 kinase ATPase signaling activity and prevention of stress mediated apoptosis of anthracyclines. Inhibiting Raf kinase activity via sorafenib may release Ask 1 and restore the apoptotic activity of doxorubicin.18 A large, randomized phase III intergroup trial, the first study guided by the National Cancer Institute for the evaluation of a systemic therapy in HCC, is currently recruiting patients with locally advanced or metastatic HCC to compare the combination of doxorubicin and sorafenib with sorafenib alone. HCC is a disease that requires a multidisciplinary team approach to ensure appropriate management of patients, regardless of the stage of the disease. Options for HCC include curative surgical approaches, palliative locoregional treatments, and systemic therapies.
Many of these options are employed through multidisciplinary clinics or teams comprised of surgeons, interventional radiologists, medical oncologists, and hepatologists, who work together to ensure the delivery of appropriate care for each BIRB 796 patient diagnosed with HCC. This team works together to improve the patient,s outcome and extend survival through coordinated management and application of the right therapy at the right time. Cases are often discussed at tumor board conferences, at which all members of the patient,s management team evaluate the current plan and, when necessary, recommend other treatment approaches. The majority of HCC cases are first screened by a hepatologist or gastroenterologist, mainly because these physicians care for patients with chronic liver disease.
Because hepatologists and gastroenterologists play a primary role in caring for these patients, they should be aware that it is necessary to be diligent regarding HCC surveillance, and they should have a working knowledge of the available treatment modalities and should refer these patients to a multidisciplinary care team if HCC develops. The hepatologist and gastroenterologist also play an active role in managing the etiologic factors of HCC as well as cirrhosis. Surgeons are key specialists in the management of HCC, although surgery may be curative in a limited number of patients. Interventional radiologists may help treat local advanced cases of HCC. The limitations of these approaches, however, should always be recognized once the disease progresses to more advanced stages that necessitate systemic therapy.
Medical oncologists are key specialists for advancedstage HCC. The introduction of sorafenib and its use as the standard of care has enforced the role of oncologists in the treatment of HCC. Continued advancement of investigational agents will ensure the role of the medical oncologist in management of the HCC patient. Oncologists should be concerned not only with the administration of the anticancer medications, but also with the management of their associated toxicities, thus, their role in the multidisciplinary team is critical. Hepatocellular carcinoma is the fifth most common cancer