Current and Emerging Treatment Strategies for Hepatocellular Carcinoma
Systemic Therapy
At the time of HCC diagnosis, 45% of patients have regional or distant disease. Patients with advanced disease are usually ineligible for curative locoregional treatments and often require systemic therapy instead. Systemic therapies for HCC are broadly classified as molecularly targeted therapy or immunotherapy with checkpoint inhibitors. HCC is often refractory to systemic chemotherapy, and chemotherapy should only be used in the context of a clinical trial.
Four systemic agents have been approved for HCC: Sorafenib, regorafenib and lenvatinib are targeted multikinase inhibitors, and nivolumab is an immuno-oncology therapeutic known as a programmed cell death protein 1 (PD-1) inhibitor. Sorafenib is the first-line standard of care for patients with metastatic or unresectable HCC and Child-Pugh A or B cirrhosis who are not candidates for transplantation or other potentially curative treatments. Regorafenib and nivolumab are approved as second-line therapies for HCC for patients previously treated with sorafenib.
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