TY  -  JOUR
AU  -  Celsa, Ciro
AU  -  Giuffrida, Paolo
AU  -  Stornello, Caterina
AU  -  Grova, Mauro
AU  -  Spatola, Federica
AU  -  Rizzo, Giacomo Emanuele Maria
AU  -  Busacca, Anita
AU  -  Cannella, Roberto
AU  -  Battaglia, Salvatore
AU  -  Cammà, Calogero
AU  -  Cabibbo, Giuseppe
T1  -  Systemic therapies for hepatocellular carcinoma:
the present and the future
PY  -  2021
Y1  -  2021-02-01
DO  -  10.1701/3559.35371
JO  -  Recenti Progressi in Medicina
JA  -  Recenti Prog Med
VL  -  112
IS  -  2
SP  -  110
EP  -  116
PB  -  Il Pensiero Scientifico Editore
SN  -  2038-1840
Y2  -  2026/04/23
UR  -  http://dx.doi.org/10.1701/3559.35371
N2  -  Summary. Hepatocellular carcinoma is diagnosed in more than half of all cases at unresectable stage when no potentially curative treatments are feasible. Since 2008, sorafenib had represented the only effective first line systemic therapy over the last decade until the approval of lenvatinib, who showed to be non-inferior to sorafenib. Recently, for the first time, a combination of immunotherapy and antiangiogenic drug, atezolizumab plus bevacizumab, was associated with a significantly longer overall survival and progression free survival compared to sorafenib, becoming the new best performing first-line approach for unresectable HCC. After several randomized controlled trials (RCTs) that have attempted to find an effective second-line therapy, regorafenib, cabozantinib, ramucirumab, nivolumab and pembrolizumab represent approved treatments for patients who failed first-line treatment. However, inclusion criteria of second-line RCTs are quite heterogeneous and no direct comparisons exist among these agents. Exciting opportunities have been found either in the combination or in the sequencing of these agents, but the optimal therapeutic strategy for these patients remains elusive. Moreover, the coexistence of cirrhosis and the competing risk of liver decompensation increase the complexity of the assessment of the net health benefit of the available therapeutic approaches. The aim of this review is to summarize the evidence on systemic treatments for unresectable HCC and to explore the future perspectives on this topic.
ER  -