Overview
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality, with a rapidly evolving landscape of treatments for all disease stages, including advanced disease 1. Recent advancements include systemic therapies such as tyrosine-kinase inhibitors (TKIs), antiangiogenics, and immune checkpoint inhibitors (ICIs) 1.Management
Systemic therapies are primary treatments for advanced stages of HCC 1.
Six treatments have been adopted into guidelines based on phase III randomized controlled trials (RCTs): sorafenib, lenvatinib, atezolizumab+bevacizumab, regorafenib, cabozantinib, and ramucirumab 1.
Immune checkpoint inhibitor (ICI) therapy has been found to be significantly more effective in patients with viral hepatitis-related HCC compared to nonviral-related HCC 1.Key Recommendations
For advanced hepatocellular carcinoma, systemic therapies including sorafenib, lenvatinib, atezolizumab+bevacizumab, regorafenib, cabozantinib, and ramucirumab are recommended based on evidence from phase III randomized controlled trials 1. (Evidence: Strong)
Consider the etiology of hepatocellular carcinoma when selecting immune checkpoint inhibitor (ICI) therapy, as it demonstrates greater efficacy in patients with viral hepatitis compared to those with nonviral-related HCC 1. (Evidence: Strong)References
1 Haber PK, Puigvehí M, Castet F, Lourdusamy V, Montal R, Tabrizian P et al.. Evidence-Based Management of Hepatocellular Carcinoma: Systematic Review and Meta-analysis of Randomized Controlled Trials (2002-2020). Gastroenterology 2021. link