From the Guidelines
Best Treatment for Hepatocellular Carcinoma (HCC)
The best treatment for HCC is a multidisciplinary approach, with atezolizumab (1200mg intravenously every 3 weeks) plus bevacizumab (15mg/kg intravenously every 3 weeks) being the first-line systemic therapy for advanced disease, as it has shown superiority over sorafenib in patients with preserved liver function 1.
Treatment Options
- For early-stage HCC, surgical resection or liver transplantation is recommended 1.
- For intermediate-stage disease, transarterial chemoembolization (TACE) with doxorubicin or cisplatin is considered 1.
- In cases of unresectable HCC, lenvatinib (12mg orally once daily) or atezolizumab plus bevacizumab may be used as alternative or subsequent therapies 1.
- It is essential to note that all patients with liver cirrhosis should undergo endoscopy to mitigate the risk of bleeding associated with bevacizumab, and nonselective beta blockers can be started immediately for small varices 1.
Important Considerations
- A multidisciplinary team, including hepatologists, diagnostic radiologists, interventional radiologists, surgeons, medical oncologists, and pathologists with hepatobiliary cancer expertise, should be involved in determining an optimal treatment strategy 1.
- The development of predictive and early response biomarkers is crucial to guide clinicians in therapeutic decisions 1.
- The treatment of HCC varies substantially across different regions, with more aggressive treatments generally employed in Asian countries 1.
Key Takeaways
- Atezolizumab plus bevacizumab is the first-line systemic treatment for advanced HCC in patients with preserved liver function 1.
- A multidisciplinary approach is essential for determining the optimal treatment strategy for HCC 1.
From the FDA Drug Label
- 3 Hepatocellular Carcinoma LENVIMA is indicated for the first-line treatment of patients with unresectable hepatocellular carcinoma (HCC).
- 5 Recommended Dosage for Hepatocellular Carcinoma (HCC) The recommended dosage of LENVIMA is based on actual body weight: 12 mg for patients greater than or equal to 60 kg or 8 mg for patients less than 60 kg. Take LENVIMA orally once daily until disease progression or until unacceptable toxicity.
The best treatment for Hepatocellular Carcinoma (HCC) according to this label is Lenvatinib (LENVIMA), specifically:
- 12 mg orally once daily for patients weighing 60 kg or more
- 8 mg orally once daily for patients weighing less than 60 kg 2
From the Research
Treatment Options for Hepatocellular Carcinoma (HCC)
The treatment for HCC depends on the stage of the tumor and liver function. The following are some of the treatment options:
- Surgical resection: recommended for early stages of the disease
- Liver transplantation: recommended for early stages of the disease
- Transarterial chemoembolization (TACE): recommended for intermediate-stage HCC with preserved liver function
- Radiofrequency ablation (RFA): approved by the U.S. Food and Drug Administration (FDA) for advanced HCC
- Tyrosine kinase inhibitors (TKIs) such as lenvatinib and sorafenib: used for advanced HCC 3, 4, 5
- Immunotherapy: including pembrolizumab, bevacizumab, tremelimumab, durvalumab, camrelizumab, and atezolizumab: used for advanced HCC 6, 7
- Anti-angiogenesis therapy: including bevacizumab: used for advanced HCC 3, 5
First-Line Treatment for Advanced HCC
The combination of atezolizumab and bevacizumab has shown superiority to sorafenib alone in survival, making it the first-line recommended treatment for advanced HCC 3, 4, 5.
- Atezolizumab plus bevacizumab: recommended as first-line therapy for advanced HCC
- Lenvatinib: recommended as first-line therapy for advanced HCC 4
- Sorafenib: was the only validated treatment for many years, but has been surpassed by newer treatments 3, 5
Second-Line Treatment for Advanced HCC
Regorafenib and other multikinase inhibitors have been validated in the second-line setting for advanced HCC 3, 4, 5.
- Regorafenib: recommended as second-line therapy for advanced HCC
- Cabozantinib and ramucirumab: also approved as second-line therapy after the failure of sorafenib 4
Emerging Therapies
Several emerging regimens by the combination of various systemic therapies are currently under clinical trials, including the combination of immune checkpoint inhibitors with anti-angiogenic drugs 3, 4, 6, 7.