AGA Systemic Therapy for Hepatocellular Carcinoma Guideline Summary

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

In patients with HCC with preserved liver function not eligible for LRT or resection or with metastatic disease, the AGA suggests atezolizumab+bevacizumab over sorafenib. ( Low , Conditional (weak) )

Comment: Gastrointestinal bleeding is a known adverse effect of bevacizumab and individuals should undergo endoscopic evaluation and treatment for esophageal varices before treatment.

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

In patients with HCC with preserved liver function not eligible for LRT or resection or with metastatic disease, who had progression of disease on sorafenib, the AGA suggests cabozantinib over no systemic therapy. ( Very Low , Conditional (weak) )

Comment: Patients who place a higher value on adverse effects associated with cabozantinib and lower value on the reduction in mortality (2.2 mo) may reasonably decline cabozantinib.

Systemic Therapy for Hepatocellular Carcinoma

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

Overview

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