Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, remains a deadly cancer with an incidence that has tripled in the United States since 1980. Individuals with HCC often present at an intermediate or advanced stage when decisions regarding systemic therapy are critical. Within the last few years, several new and novel FDA-approved treatments have become available, offering hope to patients with advances disease who are not candidates for curative treatments including surgeries. AGA has conducted a detailed review of all available literature to provide the most up-to-date clinical guidelines on the use of systemic therapy in the treatment of advanced HCC. These guidelines were published today in Gastroenterology, AGA’s official journal.
The guideline was developed to not only guide hepatologists through care and treatment of their HCC patients, but also to highlight the importance of consulting a multidisciplinary team of health care professionals – including radiologists and oncologists – when developing a treatment plan.
Top guideline recommendations
- Systematic therapies are only recommended for patients with advanced HCC not amenable to surgical or radiological treatment but with preserved liver function. First line treatments include atezolizumab/bevacizumab, sorafenib, and lenvatinib with atezolizumab/bevacizumab showing modest improvement over sorafenib and thus considered first.
See the guideline for a complete breakdown of recommended uses of currently available systemic therapies. Guideline covered only FDA approved systemic therapies including atezolizumab/bevacizumab, sorafenib, lenvatinib, cabozantinib, pembrolizumab, ramucirumab and regorafenib.
- For second line treatment, recommendations were be made for cabozantinib, pembrolizumab, ramucirumab, and regorafenib recognizing that this is an area of great limitation with likely more data in future studies.
- Systemic therapy are not recommended for patients with poor liver function.
- Systemic therapy are not recommended as adjuvant therapy for HCC
Read the AGA Clinical Practice Guidelines on Systemic Therapy for Hepatocellular Carcinoma to review all 11 recommendations that detail specific patient scenarios and best treatment options.
Resources
Clinical Decision Support Tool
