Systemic treatment for unresectable hepatocellular carcinoma

doi:10.3748/wjg.v29.i10.1551

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World Journal of Gastroenterology

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1007-9327

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World J Gastroenterol. Mar 14, 2023; 29(10): 1551-1568
Published online Mar 14, 2023. doi: 10.3748/wjg.v29.i10.1551

Systemic treatment for unresectable hepatocellular carcinoma

PathompThep Leowattana, Tawithep Leowattana, Wattana Leowattana

Wattana Leowattana, PathompThep Leowattana, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand

Tawithep Leowattana, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand

Author contributions: Leowattana W wrote the paper; Leowattana T and Leowattana P collected the data.

Conflict-of-interest statement: All the authors report no having relevant conflicts of interest for this article.

Corresponding author: Wattana Leowattana, BMed, MD, MSc, PhD, Full Professor, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi Road, Rachatawee, Bangkok 10400, Thailand. wattana.leo@mahidol.ac.th

Received: September 27, 2022
Peer-review started: September 27, 2022
First decision: January 3, 2023
Revised: January 8, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 14, 2023
Processing time: 163 Days and 18.9 Hours

Core Tip

Core Tip: Hepatocellular carcinoma (HCC) is a major health problem that is the fourth leading cause of cancer-related mortality worldwide. The 5-year survival rate was nearly 19%, but only 2% in metastatic HCC. The first oral multikinase inhibitor for the systemic treatment of advanced or unresectable HCC (uHCC) was sorafenib. However, when compared to sorafenib, the combination of atezolizumab and bevacizumab increased survival rates and was authorized as first-line treatment for uHCC. Regorafenib and cabozantinib are suggested for use as second-line drugs in the event that the disease progresses. Transarterial chemoembolization for palliative care or downstaging is also suggested. This review focused on systemic therapy for uHCC patients who are not appropriate for liver-directed therapy.