First-line treatment for HCC in patients with preserved liver function

Second-line treatment for individuals with disease progression or intolerance to first-line systemic therapy

Systemic therapy for HCC in patients with poor liver function

Systemic therapy for HCC as adjuvant therapy

Document Overview

Design and created by Guideline Central in participation with the American Gastroenterological Association.

Systemic Therapy for Hepatocellular Carcinoma

American Gastroenterological Association

Publication Date: Feb 20, 2022

Page Last Updated: Feb 12, 2026

GRADE Strength of Recommendations and Implications

Grade	Quality of Evidence
High	We are very confident that the true effect lies close to the estimate of the effect.
Moderate	We are moderately confident that the true effect lies close to that of the estimate of the effect. There is a possibility that it is substantially different.
Low	Our confidence that the true effect lies close to that of the estimate of the effect is low. The true effect may be substantially different from the estimate of the effect.
Very low	We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
Evidence / Knowledge Gap	Available evidence insufficient to determine true effect.

Grade	Strength of Recommendation
Strong “AGA recommends...”	For the Patient	For the Clinician	For policy makers
Strong “AGA recommends...”	Most individuals in this situation would want the recommended course and only a small proportion would not.	Most individuals should receive the intervention. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	The recommendation can be adapted as policy or performance measure in most situations.
Conditional (weak) “AGA suggests...”	The majority of individuals in this situation would want the suggested course, but many would not.	Different choices will be appropriate for individual patients consistent with his or her values and preferences. Use shared decision making. Decision aids may be useful in helping patients make decisions consistent with their individual risks, values, and preferences.	Policy making will require substantial debate and involvement of various stakeholders. Performance measures should assess whether decision making is appropriate.
No recommendation “AGA makes no recommendation...”		The confidence in the effect estimate is so low that any effect estimate is speculative at this time.

Full Text Guideline: www.gastrojournal.org/article/S0016-5085(21)04172-X/fulltext

Source Citation: Grace L. Su, Osama Altayar, Robert O’Shea, Raj Shah, Bassam Estfan, Candice Wenzell, Shahnaz Sultan, Yngve Falck-Ytter, AGA Clinical Practice Guideline on Systemic Therapy for Hepatocellular Carcinoma, Gastroenterology, Volume 162, Issue 3, 2022, Pages 920-934, ISSN 0016-5085, https://doi.org/10.1053/j.gastro.2021.12.276.

Document Objectives: The focus of this guideline was to provide guidance on the use of systemic therapy in the treatment of hepatocellular carcinoma (HCC).