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Absolute Contraindications Active malignancy Pregnancy and lactation Severe hypoglycemia disorders Known hypersensitivity to IGF-1 Active proliferative retinopathy Relative Contraindications Diabetes mellitus Renal impairment Cardiac impairment History of hyperplasia Family history of certain cancers Severe hepatic impairment Dosing & Administration Starting Dose 2050 mcg/day subcutaneously Begin at the lower end for sensitive patients Assess tolerance for 12 weeks before titration Therapeutic Range 50120 mcg/day for most indications Maximum dose: 200 mcg/day Individualize dosing based on response and tolerance Cycling Protocol 46 weeks on therapy 4 weeks off therapy Helps prevent receptor desensitization Supports long-term efficacy Administration Guidelines Hypoglycemia Prevention: Always administer IGF-1 LR3 with or shortly after carbohydrate-containing meals

PLoS ONE 11:e0157541

Conclusion: Our study demonstrates that pgRNA serves as a valuable predictor of recurrence in advanced HCC

GPX2 is a key antioxidant enzyme involved in the detoxification of reactive oxygen species (ROS), which are known mediators of cisplatin- and 5-FUinduced cytotoxicity [17,18,19,20]