Management of Hepatocellular Carcinoma in 2024: The Multidisciplinary Paradigm in an Evolving Treatment Landscape

Abstract

Liver cancer is the third most common cause of cancer-related deaths worldwide, and hepatocellular carcinoma (HCC) makes up the majority of liver cancer cases. Despite the stabilization of incidence rates in recent years due to effective viral hepatitis treatments, as well as improved outcomes from early detection and treatment advances, the burden of HCC is anticipated to rise again due to increasing rates of metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease. The treatment landscape is evolving and requires a multidisciplinary approach, often involving multi-modal treatments that include surgical resection, transplantation, local regional therapies, and systemic treatments. The optimal approach to the care of the HCC patient requires a multidisciplinary team involving hepatology, medical oncology, diagnostic and interventional radiology, radiation oncology, and surgery. In order to determine which approach is best, an individualized treatment plan should consider the patient's liver function, functional status, comorbidities, cancer stage, and preferences. In this review, we provide an overview of the current treatment options and key trials that have revolutionized the management of HCC. We also discuss evolving treatment paradigms for the future.

Keywords: hepatocellular carcinoma; immunotherapy; liver transplantation; locoregional therapies; multidisciplinary care; palliative care.

Figure 1

Multidisciplinary team model in HCC care.

Figure 2

BCLC HCC staging 2022. BCLC, Barcelona clinic liver cancer staging system; HCC, hepatocellular carcinoma; PS, performance status score.

Figure 3

Incorporation of palliative care in HCC care involves consideration of the cirrhosis stage, HCC stage, treatment, and goals of therapy. The level of involvement of palliative care will vary based on these factors.