Current Hepatology Reports

, Volume 18, Issue 4, pp 371–382 | Cite as

The Current Landscape of Systemic Therapies for Advanced Hepatocellular Carcinoma

  • Prachi Rana
  • John Haydek
  • Anjana PillaiEmail author
Hepatic Cancer (N Parikh, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hepatic Cancer


Purpose of review

As the global burden of HCC continues to rise, there is an overwhelming need for new systemic therapies for the treatment of advanced-stage HCC. In this review, we explore the current landscape of approved therapies for intermediate-stage HCC after progression with locoregional therapy or in those who present with advanced-stage HCC not amenable to curative options.

Recent findings

In the last 10 years, several agents have been studied in the first and second-line treatment of HCC but failed to show clinical benefit. Between 2008 and 2016, sorafenib was the sole agent used in the treatment of advanced-stage HCC. Recent strides have shown success with lenvatinib as an alternative agent for first-line treatment, and regorafenib, cabozantinib, ramucirumab, nivolumab, and pembrolizumab as second- and thrid-line agents in advanced HCC.


The next series of HCC trials are appropriately directed at combination therapies—combining targeted therapy with immunomodulators in the hopes of improving overall survival and ultimately getting closer to finding a cure.

Key Words

Hepatocellular carcinoma Liver cancer Advanced therapy Systemic therapy 


Compliance with ethical standards

Conflict of Interest

Prachi Rana and John Heydak each declare no conflicts of interest.

Anjana Pillai is on the speaker’s bureau for Eisai and Simply Speaking Hepatitis and served on speaker’s bureau for BTG. She is on the medical advisory board for Wako Diagnostics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the author


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Internal MedicineEmory UniversityAtlantaUSA
  3. 3.Department of Internal Medicine, Section of Gastroenterology, Hepatology and NutritionUniversity of Chicago MedicineChicagoUSA
  4. 4.Center for Liver DiseasesThe University of Chicago MedicineChicagoUSA

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