Systemic Therapy for Advanced Hepatocellular Carcinoma Clinical Practice Guidelines (ASCO, 2020)

American Society of Clinical Oncology (ASCO)

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

March 31, 2021

Guidelines to assist in clinical decision-making regarding first-line and subsequent therapy for patients with advanced hepatocellular carcinoma (HCC) were published in December 2020 by the American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology.[1]

First-Line Therapy

For most patients with advanced HCC, Child-Pugh class A, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1, the combination of atezolizumab and bevacizumab may be offered as first-line treatment following management of esophageal varices (when present) according to institutional guidelines.

If contraindications exist for the use of atezolizumab, bevacizumab, or both in patients with advanced HCC, Child-Pugh class A, and ECOG PS 0-1, tyrosine kinase inhibitor (TKI) therapy with sorafenib or lenvatinib may be offered as first-line treatment.

Second-Line Therapy

After first-line treatment with atezolizumab-bevacizumab, a TKI (sorafenib, lenvatinib, cabozantinib, or regorafenib) may be recommended as second-line treatment.

After first-line treatment with sorafenib or lenvatinib, a different TKI (cabozantinib or regorafenib), ramucirumab (α-fetoprotein [AFP] ≥ 400 ng/mL), or atezolizumab-bevacizumab may be recommended as second-line treatment for appropriate candidates.

After first-line therapy with sorafenib or lenvatinib, it is reasonable to consider pembrolizumab or nivolumab as an option for appropriate candidates.

For more information, please go to Hepatocellular Carcinoma (HCC).


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