Published online Apr 28, 2020. doi: 10.3748/wjg.v26.i16.1888
Peer-review started: December 28, 2019
First decision: January 11, 2020
Revised: March 27, 2020
Accepted: April 4, 2020
Article in press: April 4, 2020
Published online: April 28, 2020
During the last decades, further knowledge of hepatocellular carcinoma (HCC) molecular mechanisms has led to development of effective systemic treatments including tyrosine kinase inhibitors (TKIs) and immunotherapy. In this review, we describe first and second line systemic treatment options for advanced HCC. Several trials have evaluated new drugs for the treatment of HCC patients: In first line, lenvatinib resulted non-inferior to sorafenib and it can be used as alternative, even in the lack of evidence for sequential treatment options in second line after lenvatinib. Recently, atezolizumab plus bevacizumab have shown superiority over sorafenib in first-line. Sorafenib-regorafenib sequential administration in selected patients has opened a new paradigm of treatment in advanced HCC with a life expectancy exceeding two years. Other TKIs for second line treatment include cabozantinib and ramucirumab (specifically for patients with Alpha-fetoprotein values ≥ 400 ng/mL). The combination of TKIs with immunotherapy may represent a big step forward for these patients in the near future.
Core tip: The prognosis of advanced hepatocellular carcinoma (HCC) has been improved in the last years due to new available drugs for first and second line systemic treatments. Recent improvements in HCC molecular mechanisms have led to development of effective systemic treatments including tyrosine kinase inhibitors and immunotherapy. In this review, we describe first and second line systemic treatment options for advanced HCC focusing on sequencing therapy and comparison of different second line options.