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Liver Update: Hepatocellular Carcinoma in Elderly Patients

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eMediNexus    26 October 2021

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity.

HCC is a complex illness to manage, especially in the elderly, and even today there is a lack of prospective evidence in the literature or treatment guidelines in this population. The increase in life expectance and the peak of HCC incidence in older age enhanced the number of elderly HCC patients. Therefore, the management of elderly patients with HCC is a largely unexplored field worth investigating in clinical trials. Finally, elderly patients should be distinguished into “frail” and “fit” patients. Even if specific data do not exist in the literature to date, the evidence summarized in this review suggests the use of geriatric scales in everyday clinical practice. In particular, fit patients could receive the best standard treatment for HCC according to BCLC stage, regardless the chronological age, which should not represent one of the criteria to select patients for treatments. Finally, in the case of frail elderly patients, they should be candidates for the best supportive care and eventually referred to the palliative care unit. However, more specific and prospective data are needed in this field, and further investigations are required in order to standardize the treatment for HCC elderly patients.

Source: Pharmaceuticals 2021, 14, 233.https://doi.org/10.3390/ph14030233

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