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Title
Review article : systemic treatment in hepatocellular carcinoma
AuthorPinter, Matthias ; Peck-Radosavljevic, Markus
Published in
Alimentary Pharmacology & Therapeutics, 2018, Vol. 48, Issue 6, page 598-609
PublishedWiley-Blackwell, 2018
LanguageEnglish
Document typeJournal Article
URNurn:nbn:at:at-ubmuw:3-921 Persistent Identifier (URN)
DOI10.1111/apt.14913 
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 The work is publicly available
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Abstract (English)

Background

The approval of the tyrosine kinase inhibitor sorafenib in 2007 marked a milestone in the treatment of hepatocellular carcinoma, as sorafenib was the first systemic therapy to show a survival benefit in patients with advanced hepatocellular carcinoma. Since then many drugs failed in the first and secondline setting and it took almost another decade until further tyrosine kinase inhibitors succeeded in phase III trials.

Aim

To summarise the evolving field of systemic therapy of hepatocellular carcinoma.

Methods

We reviewed recently published studies identified from PubMed and data presented at recent meetings. Main search terms included hepatocellular carcinoma, tyrosine kinase inhibitors, immunotherapy, immune checkpoint inhibitors, sorafenib, regorafenib, lenvatinib, cabozantinib, ramucirumab, and nivolumab.

Results

We discuss the evolution of targeted therapies since the approval of sorafenib including failures and recent advances. We also elaborate the unmet need of biomarkers to guide treatment decisions and discuss the emerging field of immunotherapy in hepatocellular carcinoma.

Conclusions

The tyrosine kinase inhibitors sorafenib (first line) and regorafenib (second line) have been approved for hepatocellular carcinoma, and the immune checkpoint inhibitor nivolumab obtained conditional approval for sorafenibexperienced patients in the United States. With lenvatinib in the first line, and cabozantinib and ramucirumab in sorafenibexperienced patients, three more targeted therapies reached their primary endpoint in phase III trials and may soon be added to the treatment armamentarium.

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CC-BY-NC-License (4.0)Creative Commons Attribution - NonCommercial 4.0 International License