Abstract
Treatment of advanced hepatocellular carcinoma (HCC) is challenging. Several randomized
clinical trials are investigating the efficacy of systemic therapy, immunotherapy,
and locoregional therapy as monotherapy or combined with other modalities in the treatment
of HCC. Systemic therapy is the preferred treatment in advanced disease. To date,
multiple first-line and second-line agents received Food and Drug Administration approval.
For over a decade, sorafenib was the only first-line agent. In May 2020, combination
of atezolizumab and bevacizumab has been approved as a first-line systemic regimen.
Lenvatinib is another first-line agent that has multikinase activity. Second-line
agents include cabozantinib, regorafenib, ramucirumab, and nivolumab. Adoptive cell
transfer therapy is a highly specific immunotherapy that has shown antitumor activity
against HCC. Oncolytic viruses are genetically modified viruses that infect cancer
cells and induce apoptosis. Locoregional therapies such as transarterial chemoembolization
and radioembolization have shown a potential benefit in selected patients with advanced
HCC. In this review, we aim to summarize the treatment options available for advanced
HCC.
Keywords
hepatocellular carcinoma - systemic therapies - locoregional therapies
