Systemic Treatment for Advanced Hepatocellular Carcinoma

Area of Science:

• Hepatobiliary cancers
• Medical oncology
• Translational research

Background:

• Advanced hepatocellular carcinoma (HCC) presents a significant clinical challenge with a historically poor prognosis.
• Sorafenib has been the standard first-line treatment for HCC for ten years, but new systemic therapies are emerging.
• This review offers a practical guide to current and emerging systemic treatments for advanced HCC.

Purpose of the Study:

• To provide a comprehensive overview of systemic treatment options for advanced HCC.
• To discuss the evolving treatment landscape, including first-line and second-line therapies.
• To explore the potential role of precision medicine and combination therapies in HCC management.

Main Methods:

• Literature review of current and emerging systemic treatments for advanced HCC.
• Analysis of clinical trial data and guidelines for HCC therapy.
• Discussion of treatment selection based on patient characteristics and drug toxicity profiles.

Main Results:

• First-line treatment with sorafenib and lenvatinib improves survival in advanced HCC.
• Second-line options include regorafenib, nivolumab, pembrolizumab, ramucirumab (for AFP ≥400), and cabozantinib.
• Patient factors like performance score, Child-Pugh class, and tumor markers influence treatment outcomes.

Conclusions:

• Lenvatinib is poised to become a preferred first-line agent alongside sorafenib for advanced HCC.
• Several agents are emerging as second-line options, expanding therapeutic choices.
• Precision medicine approaches are still under development, with common driver mutations not yet yielding targeted therapies.