Systemic Therapy for Advanced Hepatocellular Carcinoma

• This guideline update adds the first-lizumab + bevacizumab (atezo-bev).
• Various treatment options are recommended for patients who have contraindications to these first-line therapy combinations, and for later-line treatment.

¹ The target population includes patients who are no longer candidates for surgical or liver-directed therapies, i.e. patients with characteristics such as multifocal and/or infiltrative disease within the liver, vascular invasion or extrahepatic spread.

² Treatment options should be discussed within a multidisciplinary team.

³ Patients in the IMbrave150 trial of atezo+bevwere required to have undergone esophagogastroduodenoscopy (EGD) within 6 months of trial initiation and to have received treatment for esophageal varices when necessary.

⁴ Considerations include underlying liver function, bleeding risk, presence of portal hypertension, extent of extrahepatic spread, tumor burden, and major vascular invasion.

⁵ While there is currently no published evidence to support a recommendation for durva+treme, the ASCO Advanced HCC Expert Panel agreed that this option may be considered following first-line treatment with atezo+bev.

⁶ There is no data available to select patients for atezo+bev vs. second-line therapy with a TKI.

⁷ Pembrolizumab or nivolumab are reasonable options that may be considered for appropriate candidates following first-line therapy with sorafenib or lenvatinib.