Systemic treatment of liver cancer: Current status and future perspectives

Table 5 Steps of systematic treatment for liver cancer and corresponding treatment procedures

Treatment stage	Type of recommendation	Recommended regimen	Applicable population	Evidence level
First-line treatment	Immune + anti-angiogenesis regimen (preferred)	Atezolizumab + bevacizumab	For unresectable patients with Child-Pugh class A who have not received previous systemic treatment	IA
		Sintilimab + bevacizumab biosimilar	For unresectable or metastatic liver cancer patients who have not received previous systemic anti-tumor treatment	IA
	Single-agent targeted therapy	Lenvatinib	For advanced liver cancer patients with unresectable liver function of Child-Pugh class A	IA
		Donafenib	For unresectable liver cancer patients who have not received previous systemic anti-tumor treatment	IA
		Sorafenib	For patients with liver function of Child-Pugh class A/B	IA
Second-line treatment	Targeted therapy	Cabozantinib	Hepatocellular carcinoma patients with Child-Pugh class A liver function who have previously received sorafenib treatment and failed	IA
		Ramucirumab	Treatment of hepatocellular carcinoma patients who have previously received sorafenib treatment and have an AFP level of ≥ 400 ng/mL	IA
	Single-agent immunotherapy	Pembrolizumab	Hepatocellular carcinoma patients who have previously received sorafenib or chemotherapy containing oxaliplatin	IA
		Nivolumab	Hepatocellular carcinoma patients who have progressed after previous sorafenib treatment or cannot tolerate sorafenib	IA
	Combination of dual immunotherapies	Nivolumab + ipilimumab	Hepatocellular carcinoma patients who have progressed after previous sorafenib treatment or cannot tolerate sorafenib	IA

AFP: Alpha-fetoprotein.