Optimizing systemic therapy for advanced hepatocellular carcinoma: the key role of liver function
Giuseppe Cabibbo1, Alessio Aghemo2, Quirino Lai3
1Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.
Summary
Systemic therapies for advanced hepatocellular carcinoma (HCC) are improving survival. This review examines treatment sequences, liver function, and cirrhosis impact for advanced HCC patients.
Area of Science:
- Hepatology and Oncology
- Clinical Pharmacology
Background:
- Advanced hepatocellular carcinoma (HCC) treatment is evolving with new systemic therapies, including immunotherapy, improving survival.
- Tyrosine kinase inhibitors remain crucial for HCC patients with contraindications to immune checkpoint inhibitors.
- Optimal sequencing of first- and second-line systemic therapies for advanced HCC is not yet established.
Purpose of the Study:
- To review the efficacy and safety of systemic agents for advanced HCC.
- To focus on the impact of underlying cirrhosis on treatment outcomes.
- To propose novel clinical outcomes for clinical trials in advanced HCC.
Main Methods:
- Systematic literature review of systemic therapies for advanced HCC.
- Analysis of treatment efficacy, safety, and sequencing strategies.
- Evaluation of the influence of liver function and cirrhosis on treatment decisions.
Main Results:
- Immunotherapy has significantly improved survival in advanced HCC.
- Sequential treatment strategies require careful consideration of liver function and potential contraindications.
- Hepatic decompensation management is critical for treatment continuation.
Conclusions:
- Optimizing systemic therapy sequences in advanced HCC is essential for maximizing patient benefit.
- Underlying cirrhosis significantly impacts treatment selection and outcomes.
- Future clinical trials should incorporate novel endpoints to better assess net health benefits.
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