Targeted therapy for hepatocellular carcinoma

Abstract

The last 3 years have seen the emergence of promising targeted therapies for the treatment of hepatocellular carcinoma (HCC). Sorafenib has been the mainstay of treatment for a decade and newer modalities were ineffective and did not confer any increased therapeutic benefit until the introduction of lenvatinib which was approved based on its non-inferiority to sorafenib. The subsequent success of regorafenib in HCC patients who progress on sorafenib treatment heralded a new era of second-line treatment and was quickly followed by ramucirumab, cabozantinib, and the most influential, immune checkpoint inhibitors (ICIs). Over the same period combination therapies, including anti-angiogenesis agents with ICIs, dual ICIs and targeted agents in conjunction with surgery or other loco-regional therapies, have been extensively investigated and have shown promise and provided the basis for exciting clinical trials. Work continues to develop additional novel therapeutic agents which could potentially augment the presently available options and understand the underlying mechanisms responsible for drug resistance, with the goal of improving the survival of patients with HCC.

Fig. 1

Overview of the targeted agents approved for HCC. ATEZO atezolizumab, BEV bevacizumab, CAM camrelizumab, LEN lenvatinib, PEM pembrolizumab, NIV nivolumab, IPI ipilimumab

Fig. 2

The primary drug resistance mainly derives from interpatient and intratumoral heterogeneity while tumor evolution during treatment leads to spatial- and temporal-heterogeneity, which cause acquired resistance. Tumor heterogeneity and clonal evolution stands as the main reasons for targeted drug resistance

Fig. 3

A schematic diagram of individualized targeted therapy integrated with novel technical platforms for HCC patients

Fig. 4

Future prospects of the targeted therapy for HCC