Systemic treatment of hepatocellular carcinoma: from sorafenib to combination therapies

Area of Science:

• Hepatobiliary cancers
• Medical oncology
• Immunotherapy

Background:

• Advanced hepatocellular carcinoma (HCC) treatment was dominated by sorafenib for nearly a decade.
• Recent advancements include checkpoint inhibitors, tyrosine kinase inhibitors (TKIs), and anti-VEGFR antibodies.
• The combination of atezolizumab and bevacizumab has emerged as a superior first-line option.

Purpose of the Study:

• To review current systemic treatment strategies for advanced HCC.
• To focus on combination therapies involving immune checkpoint inhibitors, TKIs, and locoregional therapies.
• To discuss findings from recent clinical trials and identify challenges in advanced HCC treatment.

Main Methods:

• Literature review of recent clinical trials and data on systemic HCC treatment.
• Analysis of combination therapies including immune checkpoint inhibitors, TKIs, and anti-VEGFR antibodies.
• Discussion of challenges, including the need for predictive biomarkers.

Main Results:

• The combination of atezolizumab and bevacizumab demonstrates superior efficacy as a first-line treatment for advanced HCC compared to the previous standard of care.
• Various systemic agents, including checkpoint inhibitors and TKIs, have shown efficacy.
• Combination therapies are showing promise in improving treatment outcomes.

Conclusions:

• Atezolizumab and bevacizumab combination therapy represents a paradigm shift in first-line treatment for advanced HCC.
• Further research is needed to identify predictive biomarkers for patient stratification.
• Optimizing combination strategies is crucial for improving outcomes in advanced HCC.