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. 2020 Apr;27(2):e106-e114.
doi: 10.3747/co.27.5891. Epub 2020 May 1.

Nonsurgical management of advanced hepatocellular carcinoma: a clinical practice guideline

B M Meyers  1 , J Knox  2 , R Cosby  3 , J R Beecroft  4 , K K W Chan  5 , N Coburn  5 , J Feld  6 , D Jonker  7 , A Mahmud  8 , J Ringash  2   9 ; Gastrointestinal Disease Site Group
Affiliations

Nonsurgical management of advanced hepatocellular carcinoma: a clinical practice guideline

B M Meyers et al. Curr Oncol. 2020 Apr.

Abstract

Background: Practice guidelines based on a systematic review of the literature regarding the nonsurgical management of hepatocellular carcinoma (hcc) in North America are lacking. Resection and transplantation are the foundations for cure of hcc; however, most patients are diagnosed at an advanced stage, precluding those curative treatments. A number of local or regional therapies are used and are followed by systemic therapy for advanced or progressive disease. Other treatments are available, but their efficacy, compared with those standards, is not well known.

Methods: First, systematic review questions were developed. Literature searches of the medline, embase, and Cochrane library databases (January 2000 to July 2018 or January 2005 to July 2018 depending on the question) were conducted; in addition, abstracts from the 2018 annual meeting of the American Society of Clinical Oncology were reviewed. A practice guideline was drafted that was then scrutinized by internal and external reviewers.

Results: Seventy-seven studies were included in the guideline: no guidelines, two systematic reviews, and seventy-five primary studies published in full (including one pooled analysis). Five recommendations were developed.

Conclusions: There is no evidence for or against the use of local or regional interventions other than transarterial chemoembolization for the treatment of intermediate- or advanced-stage hcc. Furthermore, there is no evidence to support the addition of sorafenib to any local or regional therapy. Sorafenib or lenvatinib are recommended for first-line systemic treatment of intermediate-stage hcc. Regorafenib or cabozantinib provide survival benefits when given as second-line treatment. Antiviral treatment is recommended in individuals with advanced hcc who are positive for the hepatitis B surface antigen.

Keywords: Nonsurgical treatments; hepatocellular carcinoma; practice guidelines; systemic therapy; tyrosine kinase inhibitors.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare the following interests: BMM has received $5000 or more in a single year to act in a consulting capacity for Eisai and has received $5000 or more in a single year for other financial support from SillaJen. He has provided expert testimony to the pan-Canadian Oncology Drug Review for Eisai. JK has received research grants from Merck, AstraZeneca, and Pfizer to support investigator-initiated trials led by JK. She was a principal investigator for an AstraZeneca trial in adjuvant therapy for hcc (emerald-2). JRB is a site principal investigator for the stop hcc trial of tare plus sorafenib compared with sorafenib alone, which has completed recruiting. NC receives salary support as Ontario Health (Cancer Care Ontario)’s clinical lead for Patient Reported Outcomes and Symptom Management. JF has received consulting fees from AbbVie and is an advisory board member for AbbVie. He has received research grants from AbbVie, Gilead Sciences, Janssen, and Fujifilm Wako Pure Chemical, and has been a principal investigator for a trial of serum biomarkers for the detection of hcc for Fujifilm Wako Pure Chemical. All other authors declare that they have no conflicts of interest to disclose.

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