Barcelona Clinic Liver Cancer (BCLC) Group. Liver Unit, Hospital Clinic Barcelona, IDIBAPS, University of Barcelona.
Centro de Investigación Médica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd).
The principal advancements in the treatment of hepatocellular carcinoma (HCC) are the use of new systemic treatments such as lenvatinib in first-line treatment and regorafenib, cabozantinib and ramucirumab in second-line treatment due to their benefits in terms of overall survival. In addition, nivolumab as a second-line agent was approved by the Food and Drug Administration (FDA) in 2017 based on improved radiological response data. Physicians and patients alike will greatly benefit from this expanded arsenal of treatments once all these new drugs for the treatment of hepatocellular carcinoma finally become available. Unfortunately, in our review of the available data we found a conspicuous lack of approved systemic treatments for HCC in the distinct setting of post-liver transplantation (LT). Careful evaluation of the clinical trials for approved systemic treatments of HCC is crucial when considering the best options for those with HCC recurrence post LT. Although several first-line or second-line treatments have been shown to be effective for HCC, each of these trials was composed of its own specific populations and those with HCC recurrence post-LT were excluded. We have also summarized from a critical and clinical point of view the issues involved in the management of patients who are candidates for systemic treatment in this era of multiple drugs for the same indication.