Department of Internal Medicine, Endocrinology, Metabolism and Geriatrics, University of Modena and Reggio Emilia and NOCSAE Baggiovara, Modena, Italy.
Hepatocellular carcinoma (HCC) is a common, treatment-resistant malignancy with a complex molecular pathogenesis. Statins are a widely used class of cholesterol-lowering drugs with potentially anticancer activity. We reviewed the evidence for a role of statins in primary and secondary chemoprevention of HCC and slowing the course of otherwise incurable primary or recurrent disease. A literature search (Key-words Statins; hepatocellular carcinoma) conducted to this end, retrieved 119 references. Here we summarize history, mechanism of action and cardiovascular use of statins and highlighted that statins can affect several pathways implicated in the development of HCC. In vitro and animal studies provide strong evidence for a favourable effect of statins on HCC. However evidence in humans is conflicting. We discuss in full detail the methodological strengths and pitfalls of 3 cohort studies suggesting that use of statins may protect from the development of HCC and of a single trial reporting increased survival in those with advanced HCC randomized to. Statins, a remarkably hepato-safe class of drugs acting on both hepatocyte and endothelial cells, also have potentially beneficial effects in lowering portal hypertension. In conclusion, there is strong experimental evidence that statins are beneficial in chemopreventing and slowing the growth of HCC. However, randomized controlled trials are necessary in order to investigate the role of statins in the chemoprevention of HCC and in slowing the course of otherwise incurable disease in humans.