Paradigm shift in the treatment options of hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is prevalent worldwide with suboptimal therapeutic outcomes. The advancement of therapeutic options and the development of new systemic therapies expand the armamentarium to tackle HCC. Treatment options should be provided based on the hierarchy of efficacy in a multidisciplinary perspective, instead of the traditional stage-guided scheme. In advanced HCC, lenvatinib has a comparable efficacy as sorafenib for the first-line therapy of HCC; while regorafenib, cabozantinib, and ramucirumab have been approved as second-line therapy after the failure of sorafenib. Immune checkpoint inhibitor therapy prolongs response rate and survival and enables long-term cure. Atezolizumab plus bevacizumab is superior to sorafenib as the first-line therapy for advanced HCC. Several emerging regimens by the combination of various systemic therapies are currently under clinical trials. Systemic therapy may be used in the neoadjuvant, adjuvant or even as initial therapy for intermediate-stage HCC. The paradigm shift of HCC treatment will improve patient outcomes.

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Taiwan perspective

“…A paradigm shift in the adoption of systemic therapy in BCLC-B HCC has occurred. 53 TLCA guidelines and clinical studies suggest that target therapy combined with TACE can be considered in highly selected patients with BCLC-B unresectable HCC with Child-Pugh A and ECOG 0-1. 10 16.6-not estimable), 55 which was consistent with the findings for the global intent-to-treat populations.…”

The changing epidemiology of liver diseases in Asia

“…The survival time of Asian HCC patients was significantly prolonged in the past decades thanks to the development and implementation of new approaches based on surgery, locoregional therapy, radiation and systemic therapy. Three groups reviewed the current treatment strategies for HCC, addressing the rapid changes in the clinical management of HCC in Asia 13–15 . Recently, the availability of new therapeutic options, with the development of new systemic therapies (molecular targeted agents and immune checkpoint inhibitors, ICIs), and new sequential therapies enabled a paradigm shift in the management of HCC.…”

Role of DTL in Hepatocellular Carcinoma and Its Impact on the Tumor Microenvironment

“…Compared with other cancer types, the therapeutic effects of advanced HCC, either surgical resection or chemo, were rather unsatisfactory, which remained a difficulty in tumor treatment ( 3 ). New systemic therapies (combined targeted therapy and immunotherapy) soon become the main treatment for advanced liver cancer ( 3 ).…”

“…Compared with other cancer types, the therapeutic effects of advanced HCC, either surgical resection or chemo, were rather unsatisfactory, which remained a difficulty in tumor treatment ( 3 ). New systemic therapies (combined targeted therapy and immunotherapy) soon become the main treatment for advanced liver cancer ( 3 ). Undoubtedly, new therapies targeting immune or cancer cells have raised hope for patients; however, not all patients showed a lasting response to such methods due to the tumor immune heterogeneity and immunotherapy sensitivity ( 4 ).…”