Author information

¹University of California, San Francisco, San Francisco, CA.

²American Society of Clinical Oncology, Alexandria, VA.

³Memorial Sloan Kettering Cancer Center and Weill Medical College at Cornell University, New York, NY.

⁴Trinity College Dublin Medical School, Dublin, Ireland.

⁵Karmanos Cancer Center, Detroit, MI.

⁶Geffen School of Medicine, UCLA, Los Angeles, CA.

⁷Penn Medicine, Philadelphia, PA.

⁸Vanderbilt Ingram Cancer Center, Nashville, TN.

⁹Atlantic Medical Group, Morristown, NJ.

¹⁰Sutter Health, San Francisco, CA.

¹¹National Cancer Hospital, Hanoi, Vietnam.

¹²Roswell Park Comprehensive Cancer Center, Buffalo, NY.

¹³Beaumont Hospital, Royal Oak, MI.

¹⁴Englewood Hospital, Englewood, NJ.

¹⁵Texas Oncology, Plano, TX.

¹⁶MD Anderson Cancer Center, Houston, TX.

¹⁷Yale Cancer Center, New Haven, CT.

¹⁸VA New York Harbor Healthcare System, Brooklyn, NY.

¹⁹California Hepatitis C Task Force, California Chronic Care Coalition, FAIR Foundation, San Francisco, CA.

²⁰University of Cincinnati, Cincinnati, OH.

²¹Yale University School of Medicine and VA Connecticut Healthcare System, West Haven, CT.

²²Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, AL.

²³Johns Hopkins Medicine, Baltimore, MD.

²⁴Yale Cancer Center and VA Connecticut Healthcare System, West Haven, CT.

Abstract

Purpose: To update an evidence-based guideline to assist in clinical decision-making for patients with advanced hepatocellular carcinoma (HCC).

Methods: ASCO convened an Expert Panel to update the 2020 guideline on systemic therapy for HCC. The panel updated the systematic review to include randomized controlled trials (RCTs) published through October 2023 and updated recommendations.

Results: Ten new RCTs met the inclusion criteria and were added to the evidence base.

Recommendations: Atezolizumab + bevacizumab (atezo + bev) or durvalumab + tremelimumab (durva + treme) may be offered first-line for patients with advanced HCC, Child-Pugh class A liver disease, and Eastern Cooperative Oncology Group performance status 0-1. Where there are contraindications to these therapies, sorafenib, lenvatinib, or durvalumab may be offered first-line. Following first-line treatment with atezo + bev, second-line therapy with a tyrosine kinase inhibitor (TKI), ramucirumab (for patients with alpha-fetoprotein [AFP] ≥400 ng/mL), durva + treme, or nivolumab + ipilimumab (nivo + ipi) may be recommended for appropriate candidates. Following first-line therapy with durva + treme, second-line therapy with a TKI is recommended. Following first-line treatment with sorafenib or lenvatinib, second-line therapy options include cabozantinib, regorafenib for patients who previously tolerated sorafenib, ramucirumab (AFP ≥400 ng/mL), nivo + ipi, or durvalumab; atezo + bev or durva + treme may be considered for patients who did not have access to these therapies in the first-line setting, and do not have contraindications. Pembrolizumab or nivolumab are also options for appropriate patients following sorafenib or lenvatinib. Third-line therapy may be considered in Child-Pugh class A patients with good PS, using one of the agents listed previously that has a nonidentical mechanism of action with previously received therapy. A cautious approach to systemic therapy is recommended for patients with Child-Pugh class B advanced HCC. Further guidance on choosing between options is included within the guideline.Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.