Hepatocellular carcinoma: Advances in systemic therapies

Area of Science:

• Hepatology
• Medical Oncology
• Translational Research

Background:

• Advanced hepatocellular carcinoma (HCC) historically had limited therapeutic options and poor outcomes.
• Sorafenib, a tyrosine kinase inhibitor, was the first systemic agent approved for advanced HCC in 2007.
• Recent advancements include targeted therapies and immunotherapies, significantly improving survival rates.

Purpose of the Study:

• To review the evolving landscape of systemic therapies for advanced HCC.
• To highlight novel combination strategies and their efficacy.
• To discuss the expanding indications for systemic therapy and future research directions.

Main Methods:

• Review of recent clinical trials and guideline updates.
• Analysis of combination therapies, including atezolizumab plus bevacizumab and durvalumab plus tremelimumab.
• Exploration of systemic therapy in neoadjuvant, adjuvant, and downstaging settings.

Main Results:

• Targeted therapies and immunotherapies have revolutionized advanced HCC treatment.
• Combination regimens like atezolizumab/bevacizumab and durvalumab/tremelimumab demonstrate encouraging efficacy.
• Systemic agents are increasingly used in conjunction with locoregional therapies and for neoadjuvant/adjuvant treatment.

Conclusions:

• The treatment paradigm for advanced HCC has shifted towards novel systemic agents and combinations.
• Further research is needed to understand real-world efficacy in specific patient subgroups and the impact of liver disease etiology.
• Personalized treatment decisions will be driven by increased understanding of pathophysiology and clinical data accumulation.