Recent advances in treatment strategies for hepatocellular carcinoma with portal vein cancer thrombus

This is a review of current practices and advances in hepatocellular carcinoma (HCC) with portal vein cancer thrombus (PVTT). The treatment strategies of HCC with PVTT are non-uniform worldwide. Systemic treatment with molecularly targeted drugs and immune checkpoint inhibitors, such as sorafenib, lenflutinib, donafenib, atezolizumab plus bevacizumab, sintilimab plus IBI305, regorafenib, pembrolizumab and anti-Cytotoxic T Lymphocyte antigen 4 (CTLA-4) was recommended by guidelines, but with limited effectiveness for HCC patients with PVTT. More and more studies indicate that aggressive local or locoregional treatments, including liver resection, liver transplantation, radiation therapy, hepatic arterial infusion chemotherapy (HAIC), transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) benefit for selected HCC patients with PVTT. In recent years, the comprehensive treatment of HCC has advanced greatly. This review aims to provide an insight into the treatment modalities available for HCC patients with PVTT.