Systemic Therapy in Metastatic Hepatocellular Carcinoma

Purpose of Review: Multiple new tyrosine kinase inhibitors, immunotherapies and anti-angiogenic therapies are now available for the treatment of advanced hepatocellular carcinoma (HCC). In this article, we reviewed the evidence supporting these new therapies. Recent Findings: The combination of atezolizumab and bevacizumab has become a new standard of care for initial systemic therapy in eligible patients, replacing sorafenib in the first line for many patients. Lenvatinib, a multikinase inhibitor, is also a new first line treatment option for patients who are not eligible for immunotherapy. Several additional options for second line treatment were also reviewed in detail in this paper. Summary: New systemic therapies for advanced HCC have prolonged overall survival. However, these new therapies are primarily approved for patients with Child–Pugh A classification with few options for patients with Child–Pugh B disease. Further work is needed to expand options for patients with more advanced liver disease and to optimize the sequencing of these new therapies. © 2022, This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.