Hepatocellular carcinoma (HCC) is a malignant liver tumor that arises from hepatocytes and has a generally very poor prognosis with a 5-year survival rate of <5% in symptomatic patients. 

Therapeutic options for HCCs fall into 5 categories: surgical interventions (tumor resection and liver transplantation, LTx), percutaneous interventions (e.g., ethanol or acetic acid injection, radiofrequency thermal ablation), transarterial interventions (embolization, chemoperfusion or chemoembolization), radiation and drugs. 

A number of systemic chemotherapies, hormonal and other drugs have been evaluated in clinical trials. While most chemotherapeutic agents, tamoxifen and interferon-alpha have not been shown to be effective in randomized controlled clinical trials, based on previous reports a number of substances deserve further clinical evaluation in qualified clinical trials, e.g., gemcitabine, thymostimulin, pravastatin, thalidomide and megestrol acetate as well as several antiangiogenic small molecules, e.g., erlotinib, sorafenib, gefitinib, as well as antiangiogenic monoclonal antibodies, e.g., bevacizumab or cetuximab, Cox-2 inhibitors in combination with capecitabine, pamidronate and others.

Based on promising data from a previous study (Kouroumalis A etal.Gut 1998; 42: 42-447), we explored the therapeutic efficacy of octreotide in a mulicenter, randomized, placebo-controlled trial including 120 patients with advanced multifocal HCC. The study revealed that octreotide alone is ineffective at this stage of the disease and should, therefore, not be given. Possibly, octreotide may be efficacious at an earlier stage of the disease and/ or in combination with other therapeutic strategies.