Systemic Therapy for Advanced Hepatocellular Carcinoma

Publication Date: March 18, 2024
Last Updated: March 19, 2024

Treatment

First-line Therapy

Recommendation 1.1

Atezo+bev or durva+treme may be offered as first-line treatment for patients with Child-Pugh class A, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0–1 advanced HCC. (, , H , S )
Qualifying statements:
  • For patients receiving atezo+bev, screening for and management of esophageal varices when present are recommended prior to initiation of therapy and according to institutional guidelines.
  • The choice between treatment options in Recommendation 1.1 should be made through a discussion involving the physician and patient (and caregiver, where applicable), and should include factors such as medical history, toxicities associated with treatment, cost, goals of treatment, patient preference, and expected treatment benefit.
  • When choosing between the two combination therapy options, consider risk of bleeding and thrombosis with the vascular endothelial growth factor (VEGF) inhibitor bevacizumab.
  • Patients with active or previously documented autoimmune disease should consider the risk of immune-related adverse effects associated with atezo and durva+treme.
618

Recommendation 1.2

Where there are contraindications to atezo+bev or durva+treme, sorafenib, lenvatinib, or durvalumab may be offered as first-line treatment for patients with Child-Pugh class A, and ECOG PS 0–1 advanced HCC. (, , I , S )
Qualifying statement:
  • The choice between treatment options should take into account the factors listed in the second qualifying statement to Recommendation 1.1.
618

Overview

Title

Systemic Therapy for Advanced Hepatocellular Carcinoma

Authoring Organization

American Society of Clinical Oncology