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Faivre S, Rimassa L, Finn RS. Molecular therapies for HCC: Looking outside the box. J Hepatol 2020; 72:342-352. [PMID: 31954496 DOI: 10.1016/j.jhep.2019.09.010] [Citation(s) in RCA: 261] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022]
Abstract
Over the past decade, sorafenib has been the only systemic agent with proven clinical efficacy for patients with unresectable hepatocellular carcinoma (HCC). Recently, lenvatinib was shown to be non-inferior to sorafenib, while regorafenib, cabozantinib, and ramucirumab were shown to be superior to placebo in patients failing sorafenib. In addition, trials of immune checkpoint inhibitors reported encouraging efficacy signals. However, apart from alpha-fetoprotein, which is used to select patients for ramucirumab, no biomarkers are available to identify patients that may respond to a specific treatment. Different synergisms have been postulated based on the potential interplay between antiangiogenic drugs and immunotherapy, with several clinical trials currently testing this hypothesis. Indeed, encouraging preliminary results of phase I studies of bevacizumab plus atezolizumab and lenvatinib plus pembrolizumab have led to the design of ongoing phase III trials, including both antiangiogenics and immune checkpoint inhibitors in the front-line setting. Other important phase II studies have tested molecular therapies directed against different novel targets, such as transforming growth factor-beta, MET (hepatocyte growth factor receptor), and fibroblast growth factor receptor 4. These studies integrated translational research with the aim of better defining the biological tumour profile and identifying tumour and blood biomarkers that select patients who may really benefit from a specific molecular therapy. Importantly, good safety profiles make these drugs suitable for future combinations. In this review, we discuss the most recent data on novel combination strategies and targets, as well as looking ahead to the future role of molecular therapies in the treatment of patients with advanced HCC.
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Affiliation(s)
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center IRCCS, Rozzano (Milan), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy.
| | - Richard S Finn
- Department of Medicine, Division of Hematology/Oncology, Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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102
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Kojima H, Nakamura K, Kupiec-Weglinski JW. Therapeutic targets for liver regeneration after acute severe injury: a preclinical overview. Expert Opin Ther Targets 2020; 24:13-24. [PMID: 31906729 DOI: 10.1080/14728222.2020.1712361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Liver transplantation is the only viable treatment with a proven survival benefit for acute liver failure (ALF). Donor organ shortage is, however, a major hurdle; hence, alternative approaches that enable liver regeneration and target acute severe hepatocellular damage are necessary.Areas covered: This article sheds light on therapeutic targets for liver regeneration and considers their therapeutic potential. ALF following extensive hepatocyte damage and small-for-size syndrome (SFSS) are illuminated for the reader while the molecular mechanisms of liver regeneration are assessed in accordance with relevant therapeutic strategies. Furthermore, liver background parameters and predictive biomarkers that might associate with liver regeneration are reviewed.Expert opinion: There are established and novel experimental strategies for liver regeneration to prevent ALF resulting from SFSS. Granulocyte-colony stimulating factor (G-CSF) is a promising agent targeting liver regeneration after acute severe injury. Autophagy and hepatocyte senescence represent attractive new targets for liver regeneration in acute severe hepatic injury. Liver support strategies, including tissue engineering, constitute novel regenerative means; the success of this is dependent on stem cell research advances. However, there is no firm clinical evidence that these supportive strategies may alleviate hepatocellular damage until liver transplantation becomes available or successful self-liver regeneration occurs.
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Affiliation(s)
- Hidenobu Kojima
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kojiro Nakamura
- Department of Surgery, Kyoto University, Kyoto, Japan.,Department of Surgery, Nishi-Kobe Medical Center, Kobe, Japan
| | - Jerzy W Kupiec-Weglinski
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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103
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Zhang CH, Li M, Lin YP, Gao Q. Systemic Therapy for Hepatocellular Carcinoma: Advances and Hopes. Curr Gene Ther 2020; 20:84-99. [PMID: 32600231 DOI: 10.2174/1566523220666200628014530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/24/2022]
Abstract
The majority of patients with hepatocellular carcinoma (HCC) are diagnosed at an advanced stage that can only benefit from systemic treatments. Although HCC is highly treatmentresistant, significant achievements have been made in the molecular targeted therapy and immunotherapy of HCC. In addition to regorafenib, cabozantinib and ramucirumab were approved for the second- line targeted treatment by the FDA after disease progression on sorafenib. Nivolumab failed to demonstrate remarkable benefit in overall survival (OS) as first-line therapy, while pembrolizumab did not achieve pre-specified statistical significance in both OS and progression-free survival (PFS) as second-line treatment. Combinations of targeted agents, immune checkpoint inhibitors and other interventions showed favorable results. In this review, we summarized the progress of systemic therapy in HCC and discussed the future directions of the treatment of HCC.
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Affiliation(s)
- Chen-Hao Zhang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
| | - Ming Li
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - You-Pei Lin
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
| | - Qiang Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University and Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Shanghai, China
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104
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Mazza G, Telese A, Al-Akkad W, Frenguelli L, Levi A, Marrali M, Longato L, Thanapirom K, Vilia MG, Lombardi B, Crowley C, Crawford M, Karsdal MA, Leeming DJ, Marrone G, Bottcher K, Robinson B, Del Rio Hernandez A, Tamburrino D, Spoletini G, Malago M, Hall AR, Godovac-Zimmermann J, Luong TV, De Coppi P, Pinzani M, Rombouts K. Cirrhotic Human Liver Extracellular Matrix 3D Scaffolds Promote Smad-Dependent TGF-β1 Epithelial Mesenchymal Transition. Cells 2019; 9:83. [PMID: 31905709 PMCID: PMC7017194 DOI: 10.3390/cells9010083] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022] Open
Abstract
An altered liver microenvironment characterized by a dysregulated extracellular matrix (ECM) supports the development and progression of hepatocellular carcinoma (HCC). The development of experimental platforms able to reproduce these physio-pathological conditions is essential in order to identify and validate new therapeutic targets for HCC. The aim of this work was to validate a new in vitro model based on engineering three-dimensional (3D) healthy and cirrhotic human liver scaffolds with HCC cells recreating the micro-environmental features favoring HCC. Healthy and cirrhotic human livers ECM scaffolds were developed using a high shear stress oscillation-decellularization procedure. The scaffolds bio-physical/bio-chemical properties were analyzed by qualitative and quantitative approaches. Cirrhotic 3D scaffolds were characterized by biomechanical properties and microarchitecture typical of the native cirrhotic tissue. Proteomic analysis was employed on decellularized 3D scaffolds and showed specific enriched proteins in cirrhotic ECM in comparison to healthy ECM proteins. Cell repopulation of cirrhotic scaffolds highlighted a unique up-regulation in genes related to epithelial to mesenchymal transition (EMT) and TGFβ signaling. This was also supported by the presence and release of higher concentration of endogenous TGFβ1 in cirrhotic scaffolds in comparison to healthy scaffolds. Fibronectin secretion was significantly upregulated in cells grown in cirrhotic scaffolds in comparison to cells engrafted in healthy scaffolds. TGFβ1 induced the phosphorylation of canonical proteins Smad2/3, which was ECM scaffold-dependent. Important, TGFβ1-induced phosphorylation of Smad2/3 was significantly reduced and ECM scaffold-independent when pre/simultaneously treated with the TGFβ-R1 kinase inhibitor Galunisertib. In conclusion, the inherent features of cirrhotic human liver ECM micro-environment were dissected and characterized for the first time as key pro-carcinogenic components in HCC development.
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Affiliation(s)
- Giuseppe Mazza
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Andrea Telese
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Walid Al-Akkad
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Luca Frenguelli
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Ana Levi
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Martina Marrali
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | | | - Kessarin Thanapirom
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Maria Giovanna Vilia
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Benedetta Lombardi
- Proteomics and Molecular Cell Dynamics, Centre for Nephrology, School of Life and Medical Sciences, University College London, London NW3 2PF, UK; (B.L.); (M.C.); (J.G.-Z.)
| | - Claire Crowley
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Institute for Child Health, Great Ormond Street Hospital, University College London, London WC1N 3JH, UK; (C.C.); (P.D.C.)
| | - Mark Crawford
- Proteomics and Molecular Cell Dynamics, Centre for Nephrology, School of Life and Medical Sciences, University College London, London NW3 2PF, UK; (B.L.); (M.C.); (J.G.-Z.)
| | - Morten A. Karsdal
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 205-207, 2730 Herlev, Denmark; (M.A.K.); (D.J.L.)
| | - Diana J. Leeming
- Nordic Bioscience, Biomarkers & Research, Herlev Hovedgade 205-207, 2730 Herlev, Denmark; (M.A.K.); (D.J.L.)
| | - Giusi Marrone
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Katrin Bottcher
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Benjamin Robinson
- Department of Bioengineering, Cellular and Molecular Biomechanics, Imperial College, London SW7 2AZ, UK; (B.R.); (A.D.R.H.)
| | - Armando Del Rio Hernandez
- Department of Bioengineering, Cellular and Molecular Biomechanics, Imperial College, London SW7 2AZ, UK; (B.R.); (A.D.R.H.)
| | - Domenico Tamburrino
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Gabriele Spoletini
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Massimo Malago
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
| | - Andrew R. Hall
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London NW3 2PF, UK
| | - Jasminka Godovac-Zimmermann
- Proteomics and Molecular Cell Dynamics, Centre for Nephrology, School of Life and Medical Sciences, University College London, London NW3 2PF, UK; (B.L.); (M.C.); (J.G.-Z.)
| | - Tu Vinh Luong
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London NW3 2PF, UK
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme, UCL Institute for Child Health, Great Ormond Street Hospital, University College London, London WC1N 3JH, UK; (C.C.); (P.D.C.)
- Specialist Neonatal and Paediatric Surgery at Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Massimo Pinzani
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
- Sheila Sherlock Liver Centre, Royal Free London NHS Foundation Trust, London NW3 2PF, UK
| | - Krista Rombouts
- Regenerative Medicine & Fibrosis Group, Institute for Liver and Digestive Health, University College London (UCL), London NW3 2PF, UK; (A.T.); (W.A.-A.); (L.F.); (A.L.); (M.M.); (K.T.); (M.G.V.); (G.M.); (K.B.); (D.T.); (G.S.); (M.M.); (A.R.H.); (T.V.L.); (M.P.)
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106
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Da Fonseca LG, Wörns MA. The alpha and ßeta in phase II trials hepatocellular carcinoma - A tale of more than radiological response? Liver Int 2019; 39:1391-1393. [PMID: 31368228 DOI: 10.1111/liv.14157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Leonardo G Da Fonseca
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Marcus-A Wörns
- Department of Internal Medicine I / Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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