Management of hepatocellular carcinoma in older patients - An overview

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, with increasing prevalence among older adults due to aging and chronic liver diseases. Efficacy of HCC treatments, particularly surgical resection, radiofrequency ablation, and trans-arterial chemoembolization appear comparable between older and younger populations. Nevertheless, data on safety profile particularly in older patients is limited, which hinders proper evidence-based decision making. Recent advancements with local liver directed and systemic immunotherapies have shown favorable outcomes in treating HCC non-surgically. The use of non-surgical treatment modalities is essential in older patients who may not be candidates for surgery due to comorbidities, reduced liver function or frailty. Older and frail patients are often underrepresented in registration trials, and trial designs seldom account for age-specific issues such as diminished organ function, drug interactions, or treatment plans tailored to preserving function and quality of life. This narrative review examines treatment in older patients with hepatocellular carcinoma, summarizing key treatment considerations, challenges in therapy, and directions for future research.