Review article: systemic treatment of hepatocellular carcinoma

• Published in: Alimentary pharmacology & therapeutics Vol. 48; no. 6; pp. 598 - 609
• Main Authors: Pinter, Matthias, Peck‐Radosavljevic, Markus
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.09.2018; John Wiley and Sons Inc
• Subjects: Anilides - therapeutic use; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antineoplastic Agents - therapeutic use; Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - pathology; Clinical trials; Cyclin-dependent kinases; Enzyme inhibitors; Hepatocellular carcinoma; Humans; Immune checkpoint inhibitors; Immunosuppressive agents; Immunotherapy; Immunotherapy - methods; Liver cancer; Liver Neoplasms - drug therapy; Liver Neoplasms - pathology; Monoclonal antibodies; Nivolumab - therapeutic use; Patients; Phenylurea Compounds - therapeutic use; Protein Kinase Inhibitors - therapeutic use; Protein-tyrosine kinase; Pyridines - therapeutic use; Quinolines - therapeutic use; Ramucirumab; Review; Sorafenib - therapeutic use; Targeted cancer therapy
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.14913

Summary 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 second‐line 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 sorafenib‐experienced patients in the United States. With lenvatinib in the first line, and cabozantinib and ramucirumab in sorafenib‐experienced patients, three more targeted therapies reached their primary endpoint in phase III trials and may soon be added to the treatment armamentarium.