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Guideline

Systemic therapy for hepatocellular carcinoma (HCC)

Guideline provides you with the most up-to-date guidance on how to use systemic therapy in patients with hepatocellular carcinoma (HCC).

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Recommendations

1. In patients with HCC with preserved liver function not eligible for locoregional therapies (LRT) or resection or with metastatic disease, AGA suggests atezolizumab+bevacizumab over sorafenib.

2. In patients with HCC with preserved liver function not eligible for LRT or resection or with metastatic disease who are not candidates for treatment with atezolizumab+bevacizumab, AGA suggests either lenvatinib or sorafenib over no systemic therapy.

3. In patients with HCC with preserved liver function not eligible for LRT or resection or with metastatic disease who had progression of disease on sorafenib, AGA suggests cabozantinib over no systemic therapy.

4. In patients with HCC with preserved liver function not eligible for LRT or resection or with metastatic disease, and who had progression of disease on sorafenib, AGA suggests using pembrolizumab over no systemic therapy.

5. In patients with HCC with preserved liver function and α-fetoprotein (AFP) >400 ng/mL not eligible for LRT or resection or with metastatic disease who had progression of disease on sorafenib, AGA suggests using ramucirumab over no systemic therapy.

6. In patients with HCC with preserved liver function not eligible for LRT or resection or with metastatic disease, who had progression of disease on sorafenib, AGA suggests regorafenib over no systemic therapy.

7. In patients with HCC with poor liver function not eligible for LRT or resection or with metastatic disease, AGA suggests against routine use of sorafenib.

8. In patients with HCC undergoing curative surgical resection, AGA suggests against adjuvant sorafenib therapy.

9. In patients with HCC undergoing curative local ablation, AGA suggests against adjuvant sorafenib therapy.

10. In patients with HCC undergoing transarterial chemoembolization (TACE) LRT, AGA suggests against adjuvant sorafenib therapy.

11. In patients with HCC undergoing TACE LRT, AGA suggests against adjuvant bevacizumab therapy.

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