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Giovanis et al. Hepatoma Research 2018;4:10 Hepatoma Research
DOI: 10.20517/2394-5079.2018.21

Review Open Access

Systemic therapies for hepatocellular carcinoma: a
recap of the current status

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Petros Giovanis , Manuela De Bona , Fabio Farinati , Andrea Buda , Riccardo Berletti , Fable Zustovich ,
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Simona D’Ippolito , Michele De Boni , Umberto Cillo , Davide Pastorelli 1
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1 Operative Unit of Medical Oncology, Santa Maria del Prato Hospital, Feltre 32032, Italy.
2 Department of Gastroenterology and Digestive Endoscopy, Santa Maria del Prato Hospital, Feltre 32032, Italy.
3 Department of Surgery, University of Padua, Padua 35128, Italy.
4 Operative Unit of Radiology and Interventional Radiology, Santa Maria del Prato Hospital, Feltre 32032, Italy.
5 Operative Unit of Medical Oncology, San Martino Hospital, Belluno 32100, Italy.
Correspondence to: Dr. Petros Giovanis, Operative Unit of Medical Oncology, Santa Maria del Prato Hospital, Via Bagnols sur Ceze 3,
Azienda Ulss 1- Dolomiti, Feltre 32032, Italy. E-mail: petros.giovanis@aulss1.veneto.it
How to cite this article: Giovanis P, De Bona M, Farinati F, Buda A, Berletti R, Zustovich F, D’Ippolito S, De Boni M, Cillo U, Pastorelli D.
Systemic therapies for hepatocellular carcinoma: a recap of the current status. Hepatoma Res 2018;4:10.
http://dx.doi.org/10.20517/2394-5079.2018.21
Received: 18 Mar 2018 First Decision: 4 Apr 2018 Revised: 10 Apr 2018 Accepted: 13 Apr 2018 Published: 27 Apr 2018
Science Editor: Guang-Wen Cao Copy Editor: Guang-Zhe Zhu Production Editor: Huan-Liang Wu

Abstract
After decades of frustrating nihilism due to lack of innovative therapeutic solutions, the onco-hepatological
community is facing up to important novelties for the treatment of intermediate and advanced stages of liver
cancer. Four new drugs have been investigated and resulted in positive data: lenvatinib resulted not inferior to the
standard of care sorafenib in first line, regorafenib and cabozantinib demonstrated prolonging survival in patients
progressed to sorafenib and nivolumab approved by FDA as option after first-line. Contemporary, the knowledge
acquired after ten years’ experience of sorafenib in patient selection and adverse events management revealed
an increase of the outcomes. Physicians dedicated to treat advanced and intermediated liver cancer are close to
live a new era where systemic treatments could have a huge impact on the disease. The aim of this review is to
anticipate this new approach at the disease, summarizing data currently available for these therapies to identify
therapeutic strategies of sequences and choosing drugs according to the patient profile.

Keywords: Hepatocellular carcinoma, liver cancer, sorafenib, regorafenib, lenvatinib, cabozantinib, nivolumab

INTRODUCTION
In the last decade the outcomes of many oncologic diseases have been dramatically transformed
consequently the introduction of novel therapies; moreover, the recourse to sequential or combination
[1,2]
strategies allowed to achieve long term benefits in overall survival (OS) . This aspect is particularly
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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