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Systemic treatment of hepatocellular carcinoma: An EASL position paper
Jordi Bruix1, Stephen L Chan2, Peter R Galle3
1BCLC Group, Liver Unit, Hospital Clínic, University of Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain.
Abstract:
The last 5 years have witnessed relevant advances in the systemic treatment of hepatocellular carcinoma. New data have emerged since the development of the EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma in 2018. Drugs licensed in some countries now include 4 oral multi-tyrosine kinase inhibitors (sorafenib, lenvatinib, regorafenib and cabozantinib), 1 anti-angiogenic antibody (ramucirumab) and 4 immune checkpoint inhibitors, alone or in combination (atezolizumab in combination with bevacizumab, ipilimumab in combination with nivolumab, nivolumab and pembrolizumab in monotherapy). Prolonged survival in excess of 2 years can be expected in most patients with sensitive tumours and well-preserved liver function that renders them fit for sequential therapies. With different choices available in any given setting, the robustness of the evidence of efficacy and a correct matching of the safety profile of a given agent with patient characteristics and preferences are key in making sound therapeutic decisions. The recommendations in this document amend the previous EASL Clinical Practice Guidelines and aim to help clinicians provide the best possible care for patients today. In view of several ongoing and promising trials, further advances in systemic therapy of hepatocellular carcinoma are foreseen in the near future and these recommendations will have to be updated regularly.
Insights
Recent advancements in hepatocellular carcinoma treatment offer prolonged survival for many patients. Updated guidelines help clinicians select optimal therapies based on efficacy and safety profiles.
Area of Science:
- Hepatobiliary Cancers
- Medical Oncology
- Clinical Practice Guidelines
Background:
- Significant progress in systemic treatments for hepatocellular carcinoma (HCC) has occurred in the last five years.
- New data necessitate updates to the 2018 European Association for the Study of the Liver (EASL) Clinical Practice Guidelines for HCC management.
Purpose of the Study:
- To amend existing EASL guidelines with current evidence on systemic HCC therapies.
- To provide clinicians with updated recommendations for optimal patient care.
Main Methods:
- Review of recent clinical trial data and drug approvals for HCC.
- Incorporation of new systemic agents, including tyrosine kinase inhibitors, antibodies, and immune checkpoint inhibitors.
Main Results:
- Several new drugs are now available, including oral multi-tyrosine kinase inhibitors (sorafenib, lenvatinib, regorafenib, cabozantinib), ramucirumab, and immune checkpoint inhibitors (atezolizumab/bevacizumab, ipilimumab/nivolumab, nivolumab, pembrolizumab).
- Patients with sensitive tumors and good liver function can achieve over two years of survival with sequential therapies.
- Therapeutic decisions require careful consideration of efficacy evidence and matching drug safety profiles with patient characteristics.
Conclusions:
- Updated recommendations aid clinicians in managing hepatocellular carcinoma with currently available systemic therapies.
- Ongoing trials suggest future advancements, necessitating regular guideline updates.
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