Related Experiment Video

Updated: Dec 4, 2025

A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
12:24

A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma

Published on: September 30, 2021

5.8K

Systemic Therapy and Sequencing Options in Advanced Hepatocellular Carcinoma: A Systematic Review and Network

Mohamad Bassam Sonbol1, Irbaz Bin Riaz2, Syed Arsalan Ahmed Naqvi3

  • 1Mayo Clinic Cancer Center, Phoenix, Arizona.

JAMA Oncology
|October 22, 2020
PubMed
Abstract

Insights

The combination of atezolizumab and bevacizumab is the standard of care for first-line advanced hepatocellular carcinoma (HCC). Regorafenib and cabozantinib are preferred for refractory HCC, with ramucirumab for patients with high AFP levels.

Area of Science:

  • Hepatology
  • Oncology
  • Clinical Trials

Background:

  • The treatment landscape for advanced hepatocellular carcinoma (HCC) is complex, lacking direct head-to-head comparisons between systemic agents.
  • Network meta-analysis (NMA) is crucial for comparing diverse treatments across trials.

Purpose of the Study:

  • To evaluate the comparative effectiveness of various systemic treatments for advanced HCC across different lines of therapy.
  • To provide evidence-based guidance for treatment selection in advanced HCC.

Main Methods:

  • Systematic review and NMA of phase 3 trials including vascular endothelial growth factor inhibitors (VEGFis), checkpoint inhibitors (CPIs), and their combinations.
  • Included first-line and refractory settings for advanced HCC, analyzing overall survival (OS) and progression-free survival (PFS).
  • Followed PRISMA guidelines, utilizing random effects models for data synthesis.

Main Results:

  • In the first-line setting, atezolizumab plus bevacizumab demonstrated superior efficacy compared to lenvatinib, sorafenib, and nivolumab.
  • For refractory HCC, regorafenib and cabozantinib showed PFS and OS benefits over placebo.
  • In patients with high alpha-fetoprotein (AFP) levels (≥400 ng/mL), regorafenib, cabozantinib, and ramucirumab offered PFS and OS benefits.

Conclusions:

  • Atezolizumab and bevacizumab combination is the new standard of care for first-line advanced HCC.
  • Regorafenib and cabozantinib are preferred options for refractory HCC, with ramucirumab as an alternative for specific patient subgroups.
  • Future research should explore novel combinations and optimal strategies for patients with prior exposure to VEGFis/CPIs.

More Related Videos

Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma09:11

Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma

Published on: May 24, 2024

902
An Oncogenic Hepatocyte-Induced Orthotopic Mouse Model of Hepatocellular Cancer Arising in the Setting of Hepatic Inflammation and Fibrosis06:38

An Oncogenic Hepatocyte-Induced Orthotopic Mouse Model of Hepatocellular Cancer Arising in the Setting of Hepatic Inflammation and Fibrosis

Published on: September 12, 2019

9.3K

Related Concept Videos

Targeted Cancer Therapies02:57

Targeted Cancer Therapies

The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
8.3K
Cancer Therapies02:49

Cancer Therapies

Cancer therapies are various modes of treatment, such as surgery, radiation therapy, and chemotherapy that are administered to cancer patients.
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...
9.6K
Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
100
Combination Therapies and Personalized Medicine02:50

Combination Therapies and Personalized Medicine

Combining two or more treatment methods increases the life span of cancer patients while reducing damage to vital organs or tissue from the overuse of a single treatment. Combination therapy also targets different cancer-inducing pathways, thus reducing the chances of developing resistance to treatment.
The combination of the drug acetazolamide and sulforaphane is a good example of combination therapy to treat cancer. The cells in the interior of a large tumor often die due to the hypoxic and...
5.7K
Treatment Resistant Cancers02:56

Treatment Resistant Cancers

Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
3.6K