- Researchers reviewed the literature on targeted therapies for intermediate and advanced nonlocoregional therapy-eligible hepatocellular carcinoma (HCC) and proposed sequencing principles to guide therapy choice.
Why this matters
- Phase 3 data are insufficient to guide later lines of treatment.
- Review of 10 phase 3 trials of first-line targeted therapy and 8 phase 3 trials of targeted therapy following sorafenib.
- Funding: Educational grants from 6 pharmaceutical companies.
- First-line therapy:
- Preferred: atezolizumab plus bevacizumab improved OS and patient-reported outcomes compared with sorafenib and is the preferred therapy.
- Alternatives: lenvatinib or sorafenib (lenvatinib was noninferior to sorafenib with respect to OS).
- Second-line therapy:
- Preferred: lenvatinib or sorafenib.
- Alternative: cabozantinib or regorafenib (both improved OS in unselected patients), ramucirumab (improved OS in patients with baseline α-fetoprotein ≥400 ng/mL), or atezolizumab plus bevacizumab.
- Third-line therapy:
- Preferred: cabozantinib, regorafenib, or ramucirumab.
- Alternative: discretion of clinician and patient.