Systemic therapies in hepatocellular carcinoma: sequencing of treatment
DOI:
https://doi.org/10.52784/27112330.148Keywords:
hepatocellular carcinoma, antineoplastic agents, systemic therapies, protein kinase inhibitors, immunotherapy, treatment, combined modality therapy.Abstract
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related morbidity and mor- tality worldwide. Most cases occur in the context of cirrhosis or chronic liver inflammation. Patients with advanced HCC had no effective therapies until 2008, when sorafenib, a multi-target tyrosine kinase inhibitor, showed beneficial results when compared to placebo in terms of survival and time to progression. Since 2016, different first and second line treatments with similar mechanisms of action (lenvatinib, regorafenib, cabozantinib, ramucirumab) have shown efficacy. However, research studies with drugs that inhibit other tumor pathways remained a top priority, and immune checkpoint inhibitors (ICIs) showed promising results in the clinical setting of HCC management. Recently, antibodies against the programmed death protein-1 (PD-1), atezolizumab combined with bevacizumab, have shown superiority over sorafenib in a randomized phase III clinical trial, becoming the first-line therapy of choice. Results from multiple phase III studies are currently emerging, which will continue to modify HCC treatment. This article reviews recent developments and changes in systemic therapies for HCC, showing the current sequencing of these treatments once they begin.
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