J.Jpn. Surg. Soc.. 124(5): 404-409, 2023

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SYSTEMIC THERAPY FOR HEPATOCELLULAR CARCINOMA

Recently, new systemic therapies have become available for the treatment of unresectable hepatocellular carcinoma, including lenvatinib, atezolizumab plus bevacizumab, and durvalumab plus tremelimumab. In phase Ⅲ trials, lenvatinib showed noninferiority in overall survival compared with sorafenib, while the other two therapies showed superiority in overall survival. Lenvatinib is characterized by its strong hypoperfusion effect in the tumor and rapid onset of therapeutic effect. The management of side effects such as fatigue is important to maintain treatment intensity and continuity. Atezolizumab plus bevacizumab regimens have been reported to have a high complete response rate of 5.5%. Immune-related adverse events and adverse events specific to bevacizumab should be noted. Durvalumab plus tremelimumab is a new treatment combining two immune checkpoint inhibitors, which as of March 2023 had only been used in a limited number of patients. Further studies are needed to determine how to administer these systemic therapies differently depending on the conditions of tumors and patients and whether combining them with other therapeutic modalities will improve outcomes. Although no effective adjuvant therapy has been established so far, the interim analysis results of the phase Ⅲ IMbrave050 trial have been released, reporting the efficacy of atezolizumab plus bevacizumab.

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