Advances in Systemic Therapy for Hepatocellular Carcinoma and Future Prospects

The focus of treatment of hepatocellular carcinoma (HCC) has shifted significantly from local therapy to systemic drug therapy. Recently, the efficacy of drug therapy for HCC has made rapid progress. We have transitioned from eras of sorafenib monotherapy and sequential therapy with multiple tyrosine kinase inhibitors that slightly improved patient prognoses, to an era where the introduction of immunotherapy combining atezolizumab and bevacizumab has achieved further improvements in patient prognosis. The availability of highly effective drugs has expanded the range of diseases treatable by drug therapy. Additionally, instead of initiating drug therapy at advanced stages, combining it with local therapies such as transarterial chemoembolization at an earlier stage with the aim of achieving a cure has become possible, improving treatment outcomes further. Currently, the number of regimens available for HCC, including combinations of multiple drugs and local therapies, has increased, leading to numerous clinical trials. Additionally, HCC cases that were previously unresectable are now resectable after drug therapy, necessitating the establishment of a resectability classification system. This review summarizes the current evidence for drug therapy for HCC and discusses future treatment strategies, treatment combinations, and prospects.