part of 10.2217/FON.15.173 © 2015 Future Medicine Ltd EDITORIAL Transarterial chemoembolization and sorafenib in patients with intermediate-stage hepatocellular carcinoma: time to enter routine clinical practice? Rodolfo Sacco* ,1 , Michela Antonucci 2 , Irene Bargellini 3 , Sara Marceglia 4 , Valeria Mismas 1 & Giuseppe Cabibbo 5 KEYWORDS • combination therapy • HCC • intermediate stage • sorafenib • TACE According to the guidelines of the European Association for the Study of the Liver (EASL), patients affected from hepatocellular carcinoma (HCC) can be classified according to the Barcelona Clínic Liver Cancer (BCLC) staging system. This classification system divides HCC patients in five stages (0, A, B, C and D) on the basis of a number of prognostic and treatment-related variables such as tumor status and liver function. A specific treat- ment approach is then proposed for each of the above-mentioned stages. Transarterial chemoembolization (TACE) is recommended as first-line therapy in the treatment of patients with intermediate-stage (BCLC-B class) HCC [1] . The efficacy of this procedure is supported by robust data [2,3] . Despite its efficacy, however, there is still a lack of standardization in treatment method- ology, and TACE protocols are widely variable both in terms of dosages and schedule (on demand vs fixed interval administration) [4] . Moreover, the long- term outcomes of patients managed with TACE are not fully satisfactory, with up to 80% of patients eventually showing tumor progression [5] and TACE can be associated with a number of contraindications [4] . Of note, patients with BCLC-B HCC present highly heterogenic features, and therefore the behavior of intermediate-stage HCC patients is difficult to anticipate [6,7] . This heterogeneity is due to a number of char- acteristics including performance status, Child-Pugh class and presence of portal vein thrombosis. Therefore, the develop- ment of an effective treatment strategy for all patients with BCLC-B HCC does not appear to be an easy task: a tailored approach to optimize the clinical outcomes in each single patient is needed [8] . Treatment options different from TACE, such as surgery, local ablation, radioembo- lization or systemic therapy, may be effec- tive in patients with intermediate-stage HCC, and research in this filed appears quite active [8] . One of the most promis- ing treatment options is the combination of different therapies [8,9] . Sorafenib, an oral multityrosine kinase inhibitor, is the only systemic therapy to be approved in patients with HCC [10] . Current guidelines and expert opinions recommend the use of sorafenib in patients 1 Department of Gastroenterology, Pisa University Hospital, Pisa, Italy 2 Section of Radiology – Di.Bi.Me.F., University of Palermo, Palermo, Italy 3 Department of Radiology, Pisa University Hospital, Pisa, Italy 4 Department of Engineering, University of Trieste, Trieste, Italy 5 Section of Gastroenterology – Di.Bi.M.I.S., University of Palermo, Palermo, Italy *Author for correspondence: r.sacco@ao-pisa.toscana.it “ ...the combination of transarterial chemoembolization and sorafenib, if proved effective, will add a new therapeutic option to the therapeutic armamentarium of hepatocellular carcinoma. ” “Transarterial chemoembolization is recommended as first-line therapy in the treatment of patients with intermediate-stage ... hepatocellular carcinoma. ” Future Oncol. (Epub ahead of print) ISSN 1479-6694 For reprint orders, please contact: reprints@futuremedicine.com