Liver, Gallbladder, and Biliary Tract Cancers

We describe areas where major inroads were initially achieved by targeting angiogenesis and by unraveling pathways in the heterogeneous tumors of mesenchymal origin—spurred by the identification of c-Kit–activating mutations in GIST and the regressions that ensued when tumors harboring these mutations were exposed to the tyrosine kinase inhibitor imatinib (Gleevec).
• Improving Harmonious Precision
• Targeted Therapy for Cancer: Asking the Right Questions

In the future, as local-regional therapy improves or as novel anti-tumor medications become available, this modality may be able to be made available to patients whose disease does not meet the current Milan criteria while still providing them with acceptable long-term outcomes.
• Transplantation or Resection for HCC: Biology Determines Outcome
• Transplantation for HCC as Part of a Balanced, Multidisciplinary Strategy

Less is known about the effects of sorafenib in patients with decompensated liver disease, or of sorafenib in combination with local therapy or in a transplant setting. Prospective trials are lacking in these areas.
• Candidacy for Sorafenib in HCC Patients: Is There a Slippery Slope
• Sorafenib for HCC: A Pragmatic Perspective

This review summarizes the current data on efficacy and rationale of adjuvant treatment for hepatocellular cancer after orthotopic liver transplantation, as well as future prospects. No adjuvant treatment is currently advocated.
• Getting a Handle on Posttransplant Recurrence of HCC
• Hepatocellular Carcinoma: The Search for Innovative Adjuvant Therapies

Preliminary results of studies employing hepatic transplantation with radiation therapy are encouraging. Although these new approaches hold promise, the prognosis in patients with biliary cancers remains poor, and the integration of novel therapeutic strategies is indicated.
• Commentary (Krishnan/Crane)
• Commentary (Small)

A 58-year-old man presented with symptoms of abdominal pain of several weeks duration. At physical evaluation, jaundice and ascites were present. In addition, a palpable mass was identified in the right upper quadrant. Surgical resection was performed.

A 68-year-old man developed hepatocellular carcinoma associated with chronic alcohol abuse and cirrhosis. He began to receive sorafenib (400 mg twice daily) as management for advanced disease. About 8 weeks after drug initiation, the patient noted the rapid onset of two nodules nearly identical in appearance.

A 57-year-old woman developed a solitary nodular hepatocellular carcinoma. After about 3 months on sorafenib, following pulmonary metastases, the patient experienced the explosive onset of a moderately pruritic cutaneous eruption.