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Merle et al. Hepatoma Res 2020;6:60 Hepatoma Research
DOI: 10.20517/2394-5079.2020.52

Review Open Access

Comparison and analysis of the efficacy of drug
therapy for liver cancer

Philippe Merle 1,2,3 , Miroslava Subic 1

1 Unité d’Hépatologie et Gastroentérologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon 69004, France.
2 Centre de Recherche en Cancérologie de Lyon, INSERM U1052, Lyon 69003, France.
3 Université Claude Bernard Lyon 1, Villeurbanne 69100, France.

Correspondence to: Prof. Philippe Merle, Unité d’Hépatologie, Groupement Hospitalier Lyon Nord, Hospices Civils de Lyon, 103
Grande rue de la Croix-Rousse, Lyon 69004, France. E-mail: philippe.merle@inserm.fr
How to cite this article: Merle P, Subic M. Comparison and analysis of the efficacy of drug therapy for liver cancer. Hepatoma Res
2020;6:60. http://dx.doi.org/10.20517/2394-5079.2020.52
Received: 18 May 2020 First Decision: 24 Jun 2020 Revised: 14 Jul 2020 Accepted: 20 Jul 2020 Published: 1 Sep 2020

Academic Editor: Shu-Kui Qin Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Received: First Decision: Revised: Accepted: Published:
Hepatocellular carcinoma (HCC) is a poor prognosis tumor when not accessible to potentially curative treatments
Science Editor: Copy Editor: Production Editor: Jing Yu such as surgical resection, thermal ablations or liver transplantation. Systemic cytotoxic chemotherapies have
shown inconsistent clinical benefit. In 2007, sorafenib, a tyrosine kinase inhibitor (TKI), was the first systemic
therapy able to significantly improve the outcome of HCC patients non-eligible for curative or loco-regional
therapies, despite a modest tolerance and low tumor objective response rate (ORR). Among the newer TKIs
approved after 2017, lenvatinib was the first to show a striking ORR and demonstrate non-inferiority vs. sorafenib
in the first-line setting. Furthermore, phase 3 trials showed the benefit of other TKIs, regorafenib and cabozantinib,
and the anti-angiogenic ramucirumab monoclonal antibody, in systemic second-line therapy. Immune checkpoint
inhibitors targeting PD1, achieved striking tumor shrinkage in some patients in monotherapy, seeming to be
associated with exciting outcomes. Unfortunately, this occurred in too few patients to improve the median overall
survival. More recently, the combination of anti-angiogenic drugs targeting the liver microenvironment with PD-1/
PD-L1 inhibitors, such as the combination of bevacizumab and atezolizumab, proved to be substantially effective
in phase 3, and other combinations of PD-1/PD-L1 and CTLA-4 inhibitors or TKIs have raised a lot of hopes for the
systemic treatment of HCC.

Keywords: Hepatocellular carcinoma, therapy, immune checkpoint inhibitors, tyrosine kinase inhibitors

© The Author(s) 2020. 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,
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