The Current Landscape of Systemic Therapies for Advanced Hepatocellular Carcinoma

Purpose of review: As the global burden of HCC continues to rise, there is an overwhelming need for new systemic therapies for the treatment of advanced-stage HCC. In this review, we explore the current landscape of approved therapies for intermediate-stage HCC after progression with locoregional therapy or in those who present with advanced-stage HCC not amenable to curative options. Recent findings: In the last 10 years, several agents have been studied in the first and second-line treatment of HCC but failed to show clinical benefit. Between 2008 and 2016, sorafenib was the sole agent used in the treatment of advanced-stage HCC. Recent strides have shown success with lenvatinib as an alternative agent for first-line treatment, and regorafenib, cabozantinib, ramucirumab, nivolumab, and pembrolizumab as second- and thrid-line agents in advanced HCC. Summary: The next series of HCC trials are appropriately directed at combination therapies—combining targeted therapy with immunomodulators in the hopes of improving overall survival and ultimately getting closer to finding a cure. © Springer Science+Business Media, LLC, part of Springer Nature 2019.