From the Guidelines
Hepatocellular carcinoma (HCC) treatment should be guided by the Barcelona Clinic Liver Cancer (BCLC) staging system, with treatment options including surgical resection, liver transplantation, local ablation therapies, transarterial chemoembolization (TACE), and systemic therapy with medications like sorafenib or lenvatinib, as well as immunotherapy with atezolizumab plus bevacizumab for advanced disease. The treatment of HCC depends on the cancer stage, liver function, and overall health of the patient 1.
Treatment Options
- Early-stage HCC may be treated with:
- Surgical resection to remove the tumor
- Liver transplantation for patients with cirrhosis
- Local ablation therapies like radiofrequency ablation (RFA) or microwave ablation to destroy small tumors
- Intermediate-stage disease may be treated with:
- Transarterial chemoembolization (TACE) to deliver chemotherapy directly to the tumor while blocking its blood supply
- Advanced HCC may require:
- Systemic therapy with medications like sorafenib (400 mg twice daily) or lenvatinib (8-12 mg daily), which are tyrosine kinase inhibitors that block cancer growth pathways
- Second-line options include regorafenib, cabozantinib, or immunotherapy with atezolizumab plus bevacizumab, which has shown superior survival to sorafenib 1
Multidisciplinary Approach
Treatment selection is typically made by a multidisciplinary team considering the BCLC staging system, and regular monitoring with imaging and alpha-fetoprotein testing is essential during treatment 1, 1.
Importance of Early Diagnosis
Early diagnosis and treatment significantly improve survival rates, as HCC is often aggressive and develops in patients with underlying liver disease 1. The NCCN Guidelines for Hepatobiliary Cancers recommend a multidisciplinary evaluation for determining an optimal treatment strategy, including hepatologists, diagnostic radiologists, interventional radiologists, surgeons, medical oncologists, and pathologists with hepatobiliary cancer expertise 1.
From the FDA Drug Label
OPDIVO, in combination with ipilimumab, is indicated for the treatment of adult patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib. STIVARGA is indicated for the treatment of patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib.
The treatment options for Hepatocellular Carcinoma (HCC) include:
- Nivolumab (OPDIVO) in combination with ipilimumab for adult patients who have been previously treated with sorafenib 2
- Regorafenib (STIVARGA) for patients who have been previously treated with sorafenib 3
From the Research
Treatment Options for Hepatocellular Carcinoma (HCC)
The treatment of HCC depends on the stage of the disease, tumor stage, patient performance status, and liver function reserve, requiring a multidisciplinary approach 4, 5. The following are some of the treatment options available:
- Curative-intent treatments:
- Locoregional therapies:
- Systemic treatments:
- Combination therapies:
- Combination of immune checkpoint inhibitors (ICIs) with targeted therapies or local ablative therapy 7
Treatment Considerations
The choice of treatment depends on the stage of the disease, with early-stage HCC managed with curative-intent therapies, and advanced disease managed with systemic treatments 4, 5, 6. The Barcelona-Clinic Liver Cancer system is commonly used to stage HCC and guide treatment decisions 6. Downstaging to transplant and bridging to transplant are also considered in certain cases 6.