ENDOCRINE TREATMENT OF HEPATOCELLULAR-CARCINOMA - ANY EVIDENCE OF BENEFIT

In the past 20 years, a number of studies have investigated the relati onship between sex hormones and Liver cancer. Experimental studies ind icate that a dynamic process, with sequential modifications in the pat tern of sex hormones in the serum and of sex hormone receptors in the liver, occurs progressively during hepatocarcinogenesis. Overall, it s eems that both androgens and oestrogens may enhance liver carcinogenes is, while androgens may also support the growth of established Liver t umours. Unfortunately, clinical studies of endocrine treatment of hepa tocellular carcinoma (HCC) have not adequately tested the suggestions from biological studies. So far, no clinical trial has been performed to test the efficacy of endocrine manipulation for the chemoprevention of HCC in cirrhotic patients nor in preventing relapse after radical resection of primary HCC. Anti-oestrogens have been the most studied a gents for the endocrine treatment of established HCC, although the rat ionale that supports their use is weaker than for anti-androgens. Stud ies with anti-androgens have produced prevalently negative results, du e to either a lack of activity or excessive toxicity. The use of chemi cal castration, which theoretically could enhance the activity of anti hormonal compounds, yielded no benefit at all. In summary, there is, a s yet, no definitive evidence that endocrine treatment favourably affe cts the outcome of patients with HCC. (C) 1998 Elsevier Science Ltd.