• Potential conflict of interest: Nothing to report.



We thank Dr. Braillon for his comments on our review “Strategies for HCC therapy and diagnostics - lessons learned from high throughput and profiling approaches”,1 although we have to say that they are neither correct nor related to the focus of our article. If he was more familiar with hepatocellular carcinoma (HCC) research, he would have recognized the dramatic increase in knowledge over the last decade. We do not want to comment on the accusation of “sensationalism”, but instead will get some points straight:

  • The intention of the review was to provide some integrative overview about the many molecular studies, especially profiling analyses, relating to the various molecular alterations that occur during HCC development and how they may, or should, impact on novel approaches to diagnosis and therapy. We neither addressed epidemiology nor prevention. Nevertheless, there is no question that hepatitis B and C viruses are the main etiologies, and they are by no means eradicated by vaccination or antiviral treatment.2 In addition, HCC is epidemic where neither alcohol, tobacco, nor obesity and diabetes represent a significant factor.

  • Knowledge about predictive molecular markers needs more than an ignorant Medline search. Clinical oncology has integrated many predictive markers—breast cancer (ER [estrogen receptor], PR [progesterone receptor], HER2/ERBB2/NEU), non–small-cell lung cancer (epidermal growth factor receptor mutations), gastric cancer (HER2/ERBB2/NEU), gastrointestinal stromal tumor (KIT) to name a few and many more (BRAF, ELM4-ALK, and others) to come soon. We are sure that testing for these markers is also available to French cancer patients.

  • Of course, it could always be better, but there is significant funding and research in epidemiology and prevention of cancer. Those who understand the topic know that molecular cancer research is not an opponent but a friend and significant driver of cancer epidemiology and prevention (and of course vice versa), which holds true also specifically in HCC. Otherwise, without molecular research, how would we know about hepatitis B virus, how it causes HCC, and that this can be prevented by vaccination3; or read the seminal articles about specific p53 mutations caused by aflatoxins, a paradigm of molecular cancer epidemiology4, 5; and…much more to come.

Kai Breuhahn Ph.D.*, Gregory Gores M.D.†, Peter Schirmacher Ph.D.*, * Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany, † Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN.