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Review
. 2019 Jun 4;6(1):HEP11.
doi: 10.2217/hep-2019-0001.

Current options and future possibilities for the systemic treatment of hepatocellular carcinoma

Jean-Luc Raoul  1 , Jean-Sébastien Frenel  1 , Judith Raimbourg  1 , Marine Gilabert  2
Affiliations
Review

Current options and future possibilities for the systemic treatment of hepatocellular carcinoma

Jean-Luc Raoul et al. Hepat Oncol. .

Abstract

Most hepatocellular carcinoma patients could not benefit from or experience disease recurrence after curative treatments. In 2007 sorafenib demonstrated efficacy in first line treatment of advanced hepatocellular carcinoma. After a decade of negative trials, in early 2019 we now have another tyrosine kinase inhibitor available in first line, lenvatinib, three other targeted therapies in second line post-sorafenib (regorafenib, cabozantinib and ramucirumab) and promising data from two immunotherapies (nivolumab and pembrolizumab). Unfortunately, no biomarkers have been identified to help guide our choice. In this short review we summarize the results of these different therapies and propose a therapeutic algorithm based on subgroup analysis. It is most likely that we will not have head-to-head comparisons in second line trials.

Keywords: cabozantinib; lenvatinib; nivolumab; pembrolizumab; ramucirumab; regorafenib; sorafenib.

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Conflict of interest statement

Financial & competing interests disclosure The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1.
Figure 1.. Proposed treatment algorithm of medical treatment in hepatocellular patients (hepatocellular carcinoma).
Immunotherapies are not on this algorithm due to absence of Phase III trials and this figure will have to be redrawn after publication of trial results. EHS: Extrahepatic spread; HBV: Hepatitis B virus infection; HCV: Hepatitis C virus infection; MVI: Macroscopic venous invasion; OH: Ethanol abuse; PS: Performance status; PVT: Portal vein trunk thrombosis.
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