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Pelizzaro et al. Hepatoma Res 2021;7:36  https://dx.doi.org/10.20517/2394-5079.2021.24  Page 5 of 7

               biomarkers of treatment response would be very useful in guiding treatment decisions. Lastly, another point
               that has to be considered is the cost-effectiveness of subsequent different lines of treatment, which still
               remains to be carefully determined.


               Significant advances in the treatments of unresectable HCC have been made in the last few years and
               additional, even greater, changes in this landscape are on the way. After the sorafenib era that lasted more
               than 10 years, the atezolizumab + bevacizumab combination therapy has emerged as the new paradigm in
               the first-line systemic treatment. Although at present this therapy is becoming the standard of care, some
               uncertainties are still present such as the patients’ amenability to this treatment in real-life clinical scenarios,
               the best second-line approach, or the specific treatment of HCC developing after HCV eradication with
               direct acting antivirals. We are witnessing a sort of rapidly evolving revolution in the field of systemic
               treatment for HCC, but many other research efforts are still to be made in order to ensure an ever-better
               survival and quality of life for patients with advanced liver cancer.


               DECLARATIONS
               Authors’ contributions
               Made substantial contributions to conception and design of the study and performed data analysis and
               interpretation: Pelizzaro F, Ramadori G, Farinati F
               All the authors equally contributed to this work.

               Availability of data and materials
               Not applicable.


               Financial support and sponsorship
               None.


               Conflicts of interest
               All authors declared that there are no conflicts of interest.


               Ethical approval and consent to participate
               Not applicable.


               Consent for publication
               Not applicable.


               Copyright
               © The Author(s) 2021.


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