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KMID : 0390320230330010001
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Chungbuk Medical Journal
2023 Volume.33 No. 1 p.1 ~ p.9
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Palliative systemic therapy for hepatocellular carcinoma
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Kim Hong-Sik
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Abstract
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Purpose: The systemic therapy of advanced hepatocellular carcinoma (HCC) has significantly evolved from molecular targeted therapy with tyrosine kinase inhibitors (TKIs) as a monotherapy to the combination therapy with immune checkpoint inhibitors (ICIs). Combination therapy with ICIs have demonstrated clinically meaningful survival benefits over the TKI monotherapy. Here, we review the updates on the current systemic therapy of advanced HCC.
Results: Sorafenib and lenvatinib were the oral TKIs that served as the only standard systemic therapy for many years. In the era of immunotherapy, multiple trials of combinational treatment strategies involving ICIs have been reported and are ongoing. In the landmark IMbrave 150 trial, atezolizumab/bevacizumab has been approved as the first-line systemic therapy and established a new standard of advanced HCC with an ICI-based regimen. Moreover, durvalumab/tremelimumab demonstrated significant survival benefit and outcomes for dual ICI therapy. Regorafenib, cabozantinib, ramucirumab, nivolumab/ipilimumab, and pembrolizumab are second-line options for patients with HCC progression while on first-line therapy. However, the best subsequent treatment regimen has not been established, and
data on progression after the ICI-based regimen are lacking.
Conclusion: Promising results of several combination therapies with ICIs have been reported in the past few years, with improved survival outcomes. The appropriate selection of systemic therapy for a patient is determined by several factors, including efficacy, toxicity, and the presence of contraindications or predictive factors. Moreover, many novel treatment strategies have been proposed and developed. These ongoing trials would further improve survival outcomes in the future.
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KEYWORD
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Hepatocellular carcinoma, Immune checkpoint inhibitor, Molecular argeted therapy
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