OnCo
cancersCancer

Hepatocellular carcinoma

Liver cancer almost always grows in a liver already damaged by hepatitis, alcohol or fatty liver disease. It is one of the most preventable cancers, and since 2020 immunotherapy combinations have roughly doubled how long people with advanced disease live.

Hepatocellular carcinoma is the dominant primary liver cancer (~75-85%) and the third leading cause of cancer death worldwide. Its defining feature is that it arises in a diseased organ: chronic hepatitis B, hepatitis C, alcohol-related and metabolic (MASLD) cirrhosis account for most cases, so the liver's remaining function (Child-Pugh, ALBI) matters as much as tumour stage. The BCLC system integrates both and maps each stage to a treatment: ablation, resection or transplantation for early disease; TACE or radioembolisation for intermediate disease; systemic therapy for advanced disease. Surveillance of at-risk patients with six-monthly ultrasound is recommended but poorly adopted, and most patients still present beyond curative stages.

Systemic therapy changed completely between 2018 and 2026. Sorafenib (SHARP, 2007) was the only option for a decade. Lenvatinib matched it (REFLECT), then IMbrave150 made atezolizumab plus bevacizumab the first regimen to beat sorafenib on survival (OS 19.2 vs 13.4 months). HIMALAYA's STRIDE regimen (single-dose tremelimumab plus durvalumab) followed with a doubling of five-year survival (19.6% vs 9.4%), and CheckMate 9DW's nivolumab plus ipilimumab reached a median OS of 23.7 months (approved 2025). Camrelizumab plus rivoceranib (CARES-310, OS 23.8 vs 15.2 months) is approved in China but has received three FDA complete response letters for manufacturing reasons, most recently in July 2026. Second-line options after sorafenib (regorafenib, cabozantinib, ramucirumab for AFP ≥400) lack data after immunotherapy, the setting most patients now reach.

The frontier is combining local and systemic therapy. Three phase 3 trials (EMERALD-1, LEAP-012, EMERALD-3) show that adding immunotherapy and anti-VEGF drugs to TACE prolongs progression-free survival by about 30%, but LEAP-012's final overall-survival hazard ratio of 0.98 shows PFS is a weak surrogate here, and adjuvant atezolizumab-bevacizumab (IMbrave050) lost its early benefit with follow-up. Open questions include the right therapy after first-line immunotherapy, the role of immunotherapy before transplantation, GPC3-directed cell therapy, and above all prevention: HBV vaccination and HCV cure could avert most cases, while MASLD-driven HCC in non-cirrhotic livers is rising and escapes surveillance.

State of the art today

  • IO doublets first line.
  • GPC3 CAR-T and bispecifics emerging.
  • Choice of regimen is driven by bleeding risk (varices), autoimmune disease and transplant candidacy rather than a predictive biomarker.
  • Radioembolisation and radiation segmentectomy offer curative-intent options for small tumours and for portal vein thrombosis.
  • Prevention works: HBV vaccination and HCV antivirals have cut incidence in Taiwan, Japan and Egypt; MASLD is the rising cause.
  • Living-donor transplantation and downstaging widen the pool of curable patients, led by Asian high-volume centres.
Show survival figures (2)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • Three first-line immunotherapy regimens with overall-survival benefit over sorafenib; median OS approaching two years and five-year survival of one in five with STRIDE.
  • TACE plus systemic therapy prolongs PFS in intermediate-stage disease in three phase 3 trials, but overall survival is unproven (LEAP-012 OS HR 0.98).
Who it affects
Show survival figures (1)

Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.

  • Roughly 900,000 liver cancer cases and 800,000 deaths a year worldwide (GLOBOCAN); ~80% of cases in Asia and Africa; the fastest-rising cancer death rate in the United States over the past two decades.

Where the cases are

Cases by country · GLOBOCAN 2022
All countries →

Site: Liver and intrahepatic bile ducts (shared total; subtype split not reported). World: 866,136 new cases, 758,725 deaths.

#CountryNew casesDeaths
1China367,657316,544
2United States of America43,49230,931
3Japan41,38826,420
4India38,70336,953
5Egypt27,94626,971
6Thailand27,93627,143
7Viet Nam24,50223,333
8Indonesia23,80523,383
9Korea, Republic of14,79112,595
10Brazil13,59913,041

ICD-10 C22 combines hepatocellular carcinoma with intrahepatic cholangiocarcinoma (HCC is roughly 75-85% of the total).

Standard of care

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Early

Resection, ablation, transplant.

NCCN Guidelines: Hepatocellular Carcinoma
Thermal ablation (RFA, microwave, cryo)Focused ultrasound & histotripsy
Intermediate

TACE/TARE ± systemic therapy.

NCCN Guidelines: Hepatocellular Carcinoma
Radioligand therapy (beta emitters)
Advanced

Atezolizumab-bevacizumab, durvalumab-tremelimumab, or nivolumab-ipilimumab.

NCCN Guidelines: Hepatocellular Carcinoma
AtezolizumabDurvalumabNivolumabIpilimumab
Prevention

Universal HBV vaccination; antiviral suppression of HBV; direct-acting antiviral cure of HCV; alcohol and metabolic risk reduction.

NCCN · Hepatobiliary Cancers
Hepatitis B and C as cancer causesHPV & HBV vaccination
Surveillance

Six-monthly ultrasound ± AFP in cirrhosis and high-risk HBV carriers; abbreviated MRI where ultrasound is inadequate.

AASLD 2023 Practice Guidance
HCC surveillance in cirrhosis (ultrasound + AFP)UltrasoundAlpha-fetoprotein (AFP)
Very early / early (BCLC 0-A)

Ablation (RFA/microwave) for ≤3 cm; resection for preserved liver function; transplantation within Milan or downstaged criteria; radiation segmentectomy as an alternative.

NCCN · Category 1 for resection/ablation/transplant
Thermal ablation (RFA, microwave, cryo)Liver transplantation for cancer (Milan criteria and beyond)Radioembolisation (TARE / SIRT, yttrium-90)BCLC staging
Intermediate (BCLC B)

TACE (conventional or DEB-TACE) or TARE; systemic therapy for high tumour burden or TACE-refractory disease; TACE + durvalumab-bevacizumab or STRIDE + lenvatinib prolong PFS (OS unproven).

NCCN · TACE category 1; combinations not yet stand…
Transarterial chemoembolisation (TACE)Radioembolisation (TARE / SIRT, yttrium-90)EMERALD-1LEAP-012EMERALD-3
Advanced (BCLC C), first line

Atezolizumab + bevacizumab (IMbrave150), STRIDE tremelimumab + durvalumab (HIMALAYA), or nivolumab + ipilimumab (CheckMate 9DW); lenvatinib or sorafenib if immunotherapy is contraindicated (transplant, active autoimmune disease).

NCCN · Category 1 (preferred) for all three IO reg…ESMO-MCBS · IMbrave150 grade 5
IMbrave150HIMALAYACheckMate 9DWAtezolizumabDurvalumabTremelimumabNivolumabIpilimumabLenvatinibSorafenib
Advanced, second line and beyond

After immunotherapy: lenvatinib, sorafenib, cabozantinib or regorafenib by extrapolation (no dedicated phase 3); ramucirumab if AFP ≥400 ng/mL; clinical trials.

NCCN · Category 2A after IO
CabozantinibRegorafenibRamucirumabLenvatinibRESORCECELESTIAL
Adjuvant after resection/ablation

No approved adjuvant therapy; IMbrave050 benefit not sustained. Surveillance imaging every 3-6 months.

IMbrave050
Portal vein tumour thrombosis

Systemic immunotherapy; Y-90 radioembolisation where TACE is contraindicated; radiotherapy to the thrombus in selected patients.

Radioembolisation (TARE / SIRT, yttrium-90)SBRT / SABR (stereotactic radiotherapy)

Subtypes & biomarkers

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Subtypes
  • Viral (HBV, HCV) HCC
  • Alcohol-related HCC
  • MASLD/MASH-related HCC (often non-cirrhotic)
  • Fibrolamellar carcinoma (young adults, DNAJB1-PRKACA fusion)
  • Combined hepatocellular-cholangiocarcinoma
  • BCLC stages 0/A, B, C, D
Biomarkers clinicians test

Target prevalence in this cancer

Target / alterationPrevalenceSource
Glypican-3
70-80%
Wikipedia
VEGF / VEGFR
n/a
Wikipedia

How common each drug target or alteration is in this cancer. Population-level and approximate; see the target page for detail. Full matrix.

History

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  1. 1941Hepatocellular carcinoma linked to cirrhosis in large autopsy series

    Establishes the disease-in-a-diseased-organ paradigm.

  2. 1964Hepatitis B surface antigen discovered (Blumberg)

    Nobel Prize 1976; leads to the vaccine.

    Hepatitis B and C as cancer causes
  3. 1984Taiwan begins universal HBV vaccination

    Childhood HCC incidence later falls ~70%.

    HPV & HBV vaccination
  4. 1996Milan criteria for liver transplantation

    Mazzaferro: ~70% five-year survival for small tumours.

    Liver transplantation for cancer (Milan criteria and beyond)
  5. 1999BCLC staging system published
    BCLC staging
  6. 2002TACE proven to prolong survival (Llovet, Lo)
    Transarterial chemoembolisation (TACE)
  7. 2007Sorafenib: first systemic therapy
  8. 2007SHARP: sorafenib, the first systemic therapy
    SHARPSorafenib
  9. 2014Direct-acting antivirals cure hepatitis C

    HCC risk falls ~70% after cure.

    Hepatitis B and C as cancer causes
  10. 2017RESORCE: regorafenib, first second-line benefit; SARAH/SIRveNIB negative for Y-90 vs sorafenib
    RESORCESARAH and SIRveNIB
  11. 2018REFLECT: lenvatinib non-inferior first line; CELESTIAL: cabozantinib second line
    REFLECTCELESTIAL
  12. 2020IMbrave150: atezolizumab-bevacizumab
    Atezolizumab
  13. 2020IMbrave150: atezolizumab + bevacizumab beats sorafenib

    First regimen to improve OS over sorafenib; new standard.

    IMbrave150Atezolizumab
  14. 2022HIMALAYA: STRIDE approved; BCLC update adds systemic therapy for some BCLC-B
    HIMALAYATremelimumab
  15. 2024EMERALD-1 and LEAP-012: TACE + systemic therapy improves PFS; HIMALAYA 5-year OS 19.6%
    EMERALD-1LEAP-012
  16. 2025CheckMate 9DW approval (nivolumab + ipilimumab); second FDA CRL for camrelizumab-rivoceranib
    CheckMate 9DWCamrelizumab + rivoceranib
  17. 2026EMERALD-3 positive for PFS; LEAP-012 final OS HR 0.98; IMbrave050 update negative; third camrelizumab-rivoceranib CRL (23 July)
    EMERALD-3LEAP-012IMbrave050CARES-310

Pipeline

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Under reviewPD-1 antibody + oral VEGFR2 inhibitor
Camrelizumab + rivoceranib
ApprovedSmall-molecule multi-kinase inhibitor (MET, VEGFR2, AXL, RET)
Cabozantinib · Cabometyx
Under reviewBispecific antibody (PD-1×VEGF)
Ivonescimab
FAPI PETEMERALD-3TACE + immunotherapy/anti-VEGFRadioembolisation (TARE / SIRT, yttrium-90)Glypican-3CAR-T cell therapyImmunotherapy downstaging to transplant with a safe washoutBlood-based HCC surveillance to replace six-monthly ultrasoundHCC surveillance in cirrhosis (ultrasound + AFP)Multi-cancer early detection (MCED)Focused ultrasound & histotripsy

Open problems

  • Liver function limits therapy.
  • Surveillance uptake in cirrhosis is poor.
  • No predictive biomarker chooses among the three first-line immunotherapy regimens; PD-L1, TMB and viral aetiology are weak.
  • Second-line therapy after immunotherapy failure is extrapolated from the sorafenib era; no dedicated phase 3 has read out.
  • TACE combinations prolong PFS but not (yet) OS; sequencing local and systemic therapy is unresolved.
  • Adjuvant therapy after curative resection remains unproven; recurrence is ~70% at five years.
  • Surveillance uptake is below 25% and ultrasound misses early tumours in obese, steatotic livers; MASLD-HCC often arises without cirrhosis.
  • Immunotherapy in transplant candidates risks rejection; safe washout intervals are undefined.
  • Child-Pugh B patients are excluded from almost every trial yet make up a large share of real-world patients.
  • Global inequity: most deaths occur in Asia and Africa where HBV vaccination, HCV treatment and systemic therapy access are uneven.

Trials

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Recruiting now (live from ClinicalTrials.gov)

Recruiting trials near you · live from ClinicalTrials.gov
Hepatocellular carcinoma
condition: hepatocellular carcinoma
Open on ClinicalTrials.gov →

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Landmark trials in OnCo

CARES-310CELESTIALCheckMate 9DWEMERALD-1EMERALD-3HIMALAYAIMbrave050IMbrave150LEAP-002LEAP-012Low-dose olanzapine for cancer anorexia (Tata Memorial)REFLECTRESORCESARAH and SIRveNIBSHARP

Expert centres

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Where the expertise is

Centres linked to this cancer in OnCo

Seeking a second opinion: ask your oncologist for a referral to a high-volume centre; most accept records and pathology by mail or telehealth. In the US, use the NCI's Find a Cancer Center tool or the nonprofit Cancer Commons, which navigates options for advanced cancers at no cost.

Questions to ask

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Bring to your appointment

Questions to ask your oncologist about Hepatocellular carcinoma

Generated from this cancer's standard of care, biomarkers, and pipeline · 27 questions

Newly diagnosed

  1. What is my exact diagnosis, stage, and grade, and which tests established them?
    Why: Everything else follows from an accurate stage and subtype.
  2. Which biomarkers have been tested on my tumour (for example AFP, GPC3, Child-Pugh / ALBI liver function, AFP, BCLC stage and performance status), and what were the results?
    Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
  3. Which subtype is my cancer, and does that change the recommended treatment?
    Why: Recognised subtypes for this cancer include ViralHCC, Alcohol-related HCC, MASLD/MASH-related HCC.
  4. Is germline (inherited) genetic testing recommended for me or my family?
    Why: Inherited variants can change treatment and matter for relatives.

Early

  1. For my situation (early), which of the standard options do you recommend and why?
    Why: Guideline options include: Resection, ablation, transplant.

Intermediate

  1. For my situation (intermediate), which of the standard options do you recommend and why?
    Why: Guideline options include: TACE/TARE ± systemic therapy.

Advanced

  1. For my situation (advanced), which of the standard options do you recommend and why?
    Why: Guideline options include: Atezolizumab-bevacizumab, durvalumab-tremelimumab, or nivolumab-ipilimumab.
  2. Am I a candidate for Atezolizumab, Durvalumab, Nivolumab or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Prevention

  1. For my situation (prevention), which of the standard options do you recommend and why?
    Why: Guideline options include: Universal HBV vaccination; antiviral suppression of HBV; direct-acting antiviral cure of HCV; alcohol and metabolic risk reduction.

Surveillance

  1. For my situation (surveillance), which of the standard options do you recommend and why?
    Why: Guideline options include: Six-monthly ultrasound ± AFP in cirrhosis and high-risk HBV carriers; abbreviated MRI where ultrasound is inadequate.

Very early / early (BCLC 0-A)

  1. For my situation (very early / early (bclc 0-a)), which of the standard options do you recommend and why?
    Why: Guideline options include: Ablation (RFA/microwave) for ≤3 cm; resection for preserved liver function; transplantation within Milan or downstaged criteria; radiation segmentectomy as an alternative.

Intermediate (BCLC B)

  1. For my situation (intermediate (bclc b)), which of the standard options do you recommend and why?
    Why: Guideline options include: TACE (conventional or DEB-TACE) or TARE; systemic therapy for high tumour burden or TACE-refractory disease; TACE + durvalumab-bevacizumab or STRIDE + lenvatinib prolong PFS (OS unproven).
  2. How do the results of EMERALD-1 and LEAP-012 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Advanced (BCLC C), first line

  1. For my situation (advanced (bclc c), first line), which of the standard options do you recommend and why?
    Why: Guideline options include: Atezolizumab + bevacizumab (IMbrave150), STRIDE tremelimumab + durvalumab (HIMALAYA), or nivolumab + ipilimumab (CheckMate 9DW); lenvatinib or sorafenib if immunotherapy is contraindicated (transplant, active autoimmune disease).
  2. Am I a candidate for Atezolizumab, Durvalumab, Tremelimumab or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of IMbrave150 and HIMALAYA apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Advanced, second line and beyond

  1. For my situation (advanced, second line and beyond), which of the standard options do you recommend and why?
    Why: Guideline options include: After immunotherapy: lenvatinib, sorafenib, cabozantinib or regorafenib by extrapolation (no dedicated phase 3); ramucirumab if AFP ≥400 ng/mL; clinical trials.
  2. Am I a candidate for Cabozantinib, Regorafenib, Ramucirumab or related drugs, and what side effects should I expect?
    Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
  3. How do the results of RESORCE and CELESTIAL apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Adjuvant after resection/ablation

  1. For my situation (adjuvant after resection/ablation), which of the standard options do you recommend and why?
    Why: Guideline options include: No approved adjuvant therapy; IMbrave050 benefit not sustained. Surveillance imaging every 3-6 months.
  2. How do the results of IMbrave050 apply to someone like me?
    Why: Trial populations differ from individual patients; ask how closely you match.

Portal vein tumour thrombosis

  1. For my situation (portal vein tumour thrombosis), which of the standard options do you recommend and why?
    Why: Guideline options include: Systemic immunotherapy; Y-90 radioembolisation where TACE is contraindicated; radiotherapy to the thrombus in selected patients.

Any stage

  1. Are there clinical trials I could join, for example of FAPI PET, Camrelizumab + rivoceranib, EMERALD-3, TACE + immunotherapy/anti-VEGF?
    Why: Trials are how the next standard of care is set; asking early keeps options open.
  2. Would a second opinion at a high-volume centre change anything, and can you help arrange it?
    Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
  3. What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
    Why: Supportive care improves quality of life and helps patients complete treatment.
  4. I read that “Liver function limits therapy”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.
  5. I read that “Surveillance uptake in cirrhosis is poor”. How does that affect my plan?
    Why: Open problems are where trials and second opinions matter most.

Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.

Everything relevant

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Direct links plus the targets, companies, and technologies of this cancer's products.

technologies

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Alcohol reduction, pricing and cancer warning labelsAnti-angiogenic therapyBariatric surgery and cancer incidenceBispecific antibodiesCAR-T cell therapyCoffee and tea intakeFAPI PETFocused ultrasound & histotripsyGlobal oncology and access in low- and middle-income countriesGLP-1 receptor agonists and obesity-related cancer riskHCC surveillance in cirrhosis (ultrasound + AFP)Histotripsy as an immune primerHPV & HBV vaccinationImmune checkpoint inhibitorsLiver transplantation for cancer (Milan criteria and beyond)Mediterranean and plant-forward dietary patternsMonoclonal antibodiesMRD / molecular residual disease testingMulti-cancer early detection (MCED)Radioembolisation (TARE / SIRT, yttrium-90)Radioligand therapy (beta emitters)SBRT / SABR (stereotactic radiotherapy)Small-molecule kinase inhibitorsThermal ablation (RFA, microwave, cryo)Transarterial chemoembolisation (TACE)Ultra-processed food and sugar-sweetened drinksUltrasound

targets

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BRAFCTLA-4FAPFGFR2Glypican-3KITMETPD-1PD-L1RETVEGF / VEGFR

drugs

16
ApprovedMonoclonal antibody (anti-PD-L1)
Atezolizumab · Tecentriq / Tecentriq Hybreza (SC)
ApprovedMonoclonal antibody (anti-VEGF)
Bevacizumab · Avastin (and biosimilars)
ApprovedSmall-molecule multi-kinase inhibitor (MET, VEGFR2, AXL, RET)
Cabozantinib · Cabometyx
Under reviewMonoclonal antibody (anti-PD-1)
Camrelizumab · AiRuiKa
Under reviewPD-1 antibody + oral VEGFR2 inhibitor
Camrelizumab + rivoceranib
ApprovedMonoclonal antibody (anti-PD-L1)
Durvalumab · Imfinzi
ApprovedMonoclonal antibody (anti-CTLA-4)
Ipilimumab · Yervoy
Under reviewBispecific antibody (PD-1×VEGF)
Ivonescimab
ApprovedSmall-molecule multi-kinase inhibitor (VEGFR, FGFR, PDGFR, RET, KIT)
Lenvatinib · Lenvima
ApprovedMonoclonal antibody (anti-PD-1)
Nivolumab · Opdivo / Opdivo Qvantig (SC)
ApprovedMonoclonal antibody (anti-PD-1)
Pembrolizumab · Keytruda / Keytruda Qlex (SC)
ApprovedMonoclonal antibody (anti-VEGFR2)
Ramucirumab · Cyramza
ApprovedSmall-molecule multi-kinase inhibitor
Regorafenib · Stivarga
ApprovedSmall-molecule multi-kinase inhibitor (VEGFR, PDGFR, RAF)
Sorafenib · Nexavar
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
ApprovedMonoclonal antibody (anti-CTLA-4)
Tremelimumab · Imjudo

companies

16
AkesoAstraZenecaBayerBeOne Medicines (formerly BeiGene)Boston ScientificBristol Myers SquibbEisaiElevar Therapeutics (HLB)Eli Lilly (incl. Loxo)ExelixisIpsenJiangsu Hengrui PharmaceuticalsMerck & Co. (MSD)Roche / GenentechSirtex MedicalSummit Therapeutics

institutions

44
Asan Medical CenterAustralasian Gastro-Intestinal Trials GroupBeatson West of Scotland Cancer Centre / CRUK Scotland InstituteCancer Center Clínica Universidad de Navarra / CIMAChang Gung Memorial HospitalChinese PLA General HospitalChinese Society of Clinical OncologyChulabhorn Hospital / Chulabhorn Royal AcademyComprehensive Cancer Center Tübingen-StuttgartDharmais National Cancer CenterFirst Affiliated Hospital of Sun Yat-sen UniversityFox Chase Cancer CenterGates FoundationGunma University Heavy Ion Medical CenterGustave RoussyHo Chi Minh City Oncology HospitalHokkaido University HospitalHospital Clínic de Barcelona / IDIBAPSInstitut PasteurIRCCS Humanitas Research HospitalIstituto Nazionale Tumori IRCCS Fondazione G. PascaleKorean Cancer Study GroupKorle Bu Teaching HospitalKyushu University HospitalMayo ClinicMemorial Sloan Kettering Cancer CenterNational Cancer Center KoreaNational Cancer Centre SingaporeNational Cancer Institute, Cairo UniversityNational Taiwan University HospitalOsaka International Cancer InstitutePrince of Wales Hospital / Chinese University of Hong KongQST Hospital (National Institutes for Quantum Science and Technology)Queen Mary Hospital / University of Hong KongSeoul National University HospitalSiriraj Hospital, Mahidol UniversitySun Yat-sen University Cancer CenterTaipei Veterans General HospitalTongji Hospital, Huazhong University of Science and TechnologyUganda Cancer InstituteUniversity Hospital Düsseldorf / CIO DüsseldorfUniversity of Hawai'i Cancer CenterVietnam National Cancer Hospital (K Hospital)Zhongshan Hospital, Fudan University

pathways

5
Lipid synthesis, uptake & cholesterolOncogenic virusesThe angiogenic switch & tumour vesselsVEGF angiogenesisWnt / β-catenin

terms

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Alcohol-attributable cancerAlpha-fetoprotein (AFP)BCLC stagingChild-Pugh and ALBI liver-function scoresChild-Pugh scoreCirrhosisDosimetryDownstaging and conversion therapyHepatectomy (liver resection)Hepatitis B and C as cancer causesLiver-directed therapy (TACE, TARE, HAI, ablation)Malignant pleural effusion and ascitesMetabolic syndrome and insulin resistanceMicrowave ablation (MWA)Obesity-related cancers (IARC list of 13)Portal vein tumour thrombus (macrovascular invasion)Radiofrequency ablation (RFA)Resectable, borderline resectable and unresectableTACE (transarterial chemoembolisation)TARE / SIRT (radioembolisation with yttrium-90)Tumour marker

trials

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CARES-310CELESTIALCheckMate 9DWEMERALD-1EMERALD-3HIMALAYAIMbrave050IMbrave150LEAP-002LEAP-012Low-dose olanzapine for cancer anorexia (Tata Memorial)REFLECTRESORCESARAH and SIRveNIBSHARP

pairings

3
Caution: bevacizumab-based regimens with untreated varicesPD-1 blockade + VEGF inhibitionTACE + immunotherapy/anti-VEGF

ideas

23
A delivery-science moonshot for prevention we already ownA Global Fund for cancer care in low- and middle-income countriesA pragmatic trial of statins to prevent liver cancer in people with cirrhosisA ten-dollar blood test for the five cancers that kill most people in poorer countriesA trial of GLP-1 weight-loss drugs with cancer as the primary outcomeBlood-based HCC surveillance to replace six-monthly ultrasoundBurden-matched funding for trials led in low- and middle-income countriesBurden-weighted portfolio targets for every major cancer funderCancer warnings on alcohol labels, evaluated as a natural experimentCure hepatitis C in prisons and drug services, and enrol the cured in liver cancer surveillanceDevice-agnostic public trials of ablation technologies against surgeryEliminate infection-caused cancers: HPV, hepatitis B and C, H. pylori and EBVEvaluate alcohol minimum unit pricing against cancer incidenceEvery routine CT scan checked by AI for early cancer signs, with a tracked follow-up pathwayImmunotherapy downstaging to transplant with a safe washoutIn vivo CAR-T against solid-tumour antigensKeep a freshly removed tumour alive on a pump and test drugs in itKidney and liver impairment dosing studies completed before approval, not years afterLink bariatric and GLP-1 registries to cancer registries in every country that has bothMechanically pulverise one tumour with ultrasound to wake the immune systemMinimum alcohol pricing evaluated with cancer endpointsReplace six-monthly ultrasound with a blood test for liver cancer in cirrhosisTreat everyone with chronic hepatitis B to prevent liver cancer

collections

2
CSCO guidelines (China)Japanese oncology guidelines (JSMO, JSCO and organ societies)

people

8
Alan P. VenookAudre LordeHo Yeong LimMiriam MeradSung-Gyu LeeTheodore S. HongTheodore S. LawrenceThomas U. Marron

bottlenecks

6
Funding follows fashion, not burdenMost lethal cancers are found lateMost of the world has almost no cancer carePain relief and palliative care are unavailable to mostPrevention we already have is not deployedTrials do not represent the people who get cancer

key papers

3
Alcohol caused an estimated 741,000 cancers worldwide in 2020IARC verdict: excess body fat causes 13 cancersIMbrave150: atezolizumab plus bevacizumab replaces sorafenib as first treatment for advanced liver cancer

Key papers

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observationalLancet Oncology 2021
Alcohol caused an estimated 741,000 cancers worldwide in 2020

There is no safe level of alcohol for cancer risk, and the risk is highest for cancers of the mouth, throat, oesophagus, liver, bowel and breast. Public awareness is low; most people do not know alcohol causes breast cancer. Warning labels and minimum pricing are the policy levers being debated.

rctNew England Journal of Medicine 2020changed practice
IMbrave150: atezolizumab plus bevacizumab replaces sorafenib as first treatment for advanced liver cancer

Patients with advanced liver cancer and good liver function should be offered atezolizumab plus bevacizumab (or durvalumab plus tremelimumab) rather than sorafenib as first treatment; median survival is now around 19 months and about a quarter of patients respond. Endoscopy to treat varices before starting bevacizumab is essential because of bleeding risk. Patients with poorer liver function (Child-Pugh B) or autoimmune disease or transplants were not studied.

reviewNew England Journal of Medicine 2016changed practice
IARC verdict: excess body fat causes 13 cancers

Maintaining a healthy weight is now established cancer prevention for over a dozen cancer types. For clinicians and policymakers, obesity belongs alongside tobacco and alcohol in prevention strategy. Whether intentional weight loss in adulthood reverses risk is still being studied, including in trials of GLP-1 drugs.

Latest papers

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Literature trend8,871 papers in the last 12 months-2% vs prior 12How this is computed
Latest papers · live from Europe PMC
Open in Europe PMC

Query for this cancer: (TITLE:"Hepatocellular carcinoma" OR ABSTRACT:"Hepatocellular carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Hepatocellular carcinoma, not a curated reading list.

Connected

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Pages like this

not linked directly; found by shared links

technologies

24
Alcohol reduction, pricing and cancer warning labelsAnti-angiogenic therapyBariatric surgery and cancer incidenceCAR-T cell therapyCoffee and tea intakeFAPI PETFocused ultrasound & histotripsyGlobal oncology and access in low- and middle-income countriesGLP-1 receptor agonists and obesity-related cancer riskHCC surveillance in cirrhosis (ultrasound + AFP)Histotripsy as an immune primerHPV & HBV vaccinationImmune checkpoint inhibitorsLiver transplantation for cancer (Milan criteria and beyond)Mediterranean and plant-forward dietary patternsMulti-cancer early detection (MCED)Radioembolisation (TARE / SIRT, yttrium-90)Radioligand therapy (beta emitters)SBRT / SABR (stereotactic radiotherapy)Small-molecule kinase inhibitorsThermal ablation (RFA, microwave, cryo)Transarterial chemoembolisation (TACE)Ultra-processed food and sugar-sweetened drinksUltrasound

targets

7
CTLA-4FAPGlypican-3METPD-1PD-L1VEGF / VEGFR

drugs

16
ApprovedMonoclonal antibody (anti-PD-L1)
Atezolizumab · Tecentriq / Tecentriq Hybreza (SC)
ApprovedMonoclonal antibody (anti-VEGF)
Bevacizumab · Avastin (and biosimilars)
ApprovedSmall-molecule multi-kinase inhibitor (MET, VEGFR2, AXL, RET)
Cabozantinib · Cabometyx
Under reviewMonoclonal antibody (anti-PD-1)
Camrelizumab · AiRuiKa
Under reviewPD-1 antibody + oral VEGFR2 inhibitor
Camrelizumab + rivoceranib
ApprovedMonoclonal antibody (anti-PD-L1)
Durvalumab · Imfinzi
ApprovedMonoclonal antibody (anti-CTLA-4)
Ipilimumab · Yervoy
Under reviewBispecific antibody (PD-1×VEGF)
Ivonescimab
ApprovedSmall-molecule multi-kinase inhibitor (VEGFR, FGFR, PDGFR, RET, KIT)
Lenvatinib · Lenvima
ApprovedMonoclonal antibody (anti-PD-1)
Nivolumab · Opdivo / Opdivo Qvantig (SC)
ApprovedMonoclonal antibody (anti-PD-1)
Pembrolizumab · Keytruda / Keytruda Qlex (SC)
ApprovedMonoclonal antibody (anti-VEGFR2)
Ramucirumab · Cyramza
ApprovedSmall-molecule multi-kinase inhibitor
Regorafenib · Stivarga
ApprovedSmall-molecule multi-kinase inhibitor (VEGFR, PDGFR, RAF)
Sorafenib · Nexavar
ApprovedMonoclonal antibody (anti-PD-1)
Tislelizumab · Tevimbra
ApprovedMonoclonal antibody (anti-CTLA-4)
Tremelimumab · Imjudo

companies

12
AstraZenecaBayerBoston ScientificBristol Myers SquibbEisaiElevar Therapeutics (HLB)Eli Lilly (incl. Loxo)ExelixisJiangsu Hengrui PharmaceuticalsMerck & Co. (MSD)Roche / GenentechSirtex Medical

institutions

44
Asan Medical CenterAustralasian Gastro-Intestinal Trials GroupBeatson West of Scotland Cancer Centre / CRUK Scotland InstituteCancer Center Clínica Universidad de Navarra / CIMAChang Gung Memorial HospitalChinese PLA General HospitalChinese Society of Clinical OncologyChulabhorn Hospital / Chulabhorn Royal AcademyComprehensive Cancer Center Tübingen-StuttgartDharmais National Cancer CenterFirst Affiliated Hospital of Sun Yat-sen UniversityFox Chase Cancer CenterGates FoundationGunma University Heavy Ion Medical CenterGustave RoussyHo Chi Minh City Oncology HospitalHokkaido University HospitalHospital Clínic de Barcelona / IDIBAPSInstitut PasteurIRCCS Humanitas Research HospitalIstituto Nazionale Tumori IRCCS Fondazione G. PascaleKorean Cancer Study GroupKorle Bu Teaching HospitalKyushu University HospitalMayo ClinicMemorial Sloan Kettering Cancer CenterNational Cancer Center KoreaNational Cancer Centre SingaporeNational Cancer Institute, Cairo UniversityNational Taiwan University HospitalOsaka International Cancer InstitutePrince of Wales Hospital / Chinese University of Hong KongQST Hospital (National Institutes for Quantum Science and Technology)Queen Mary Hospital / University of Hong KongSeoul National University HospitalSiriraj Hospital, Mahidol UniversitySun Yat-sen University Cancer CenterTaipei Veterans General HospitalTongji Hospital, Huazhong University of Science and TechnologyUganda Cancer InstituteUniversity Hospital Düsseldorf / CIO DüsseldorfUniversity of Hawai'i Cancer CenterVietnam National Cancer Hospital (K Hospital)Zhongshan Hospital, Fudan University

pathways

5
Lipid synthesis, uptake & cholesterolOncogenic virusesThe angiogenic switch & tumour vesselsVEGF angiogenesisWnt / β-catenin

terms

21
Alcohol-attributable cancerAlpha-fetoprotein (AFP)BCLC stagingChild-Pugh and ALBI liver-function scoresChild-Pugh scoreCirrhosisDosimetryDownstaging and conversion therapyHepatectomy (liver resection)Hepatitis B and C as cancer causesLiver-directed therapy (TACE, TARE, HAI, ablation)Malignant pleural effusion and ascitesMetabolic syndrome and insulin resistanceMicrowave ablation (MWA)Obesity-related cancers (IARC list of 13)Portal vein tumour thrombus (macrovascular invasion)Radiofrequency ablation (RFA)Resectable, borderline resectable and unresectableTACE (transarterial chemoembolisation)TARE / SIRT (radioembolisation with yttrium-90)Tumour marker

trials

15
CARES-310CELESTIALCheckMate 9DWEMERALD-1EMERALD-3HIMALAYAIMbrave050IMbrave150LEAP-002LEAP-012Low-dose olanzapine for cancer anorexia (Tata Memorial)REFLECTRESORCESARAH and SIRveNIBSHARP

pairings

3
Caution: bevacizumab-based regimens with untreated varicesPD-1 blockade + VEGF inhibitionTACE + immunotherapy/anti-VEGF

ideas

23
A delivery-science moonshot for prevention we already ownA Global Fund for cancer care in low- and middle-income countriesA pragmatic trial of statins to prevent liver cancer in people with cirrhosisA ten-dollar blood test for the five cancers that kill most people in poorer countriesA trial of GLP-1 weight-loss drugs with cancer as the primary outcomeBlood-based HCC surveillance to replace six-monthly ultrasoundBurden-matched funding for trials led in low- and middle-income countriesBurden-weighted portfolio targets for every major cancer funderCancer warnings on alcohol labels, evaluated as a natural experimentCure hepatitis C in prisons and drug services, and enrol the cured in liver cancer surveillanceDevice-agnostic public trials of ablation technologies against surgeryEliminate infection-caused cancers: HPV, hepatitis B and C, H. pylori and EBVEvaluate alcohol minimum unit pricing against cancer incidenceEvery routine CT scan checked by AI for early cancer signs, with a tracked follow-up pathwayImmunotherapy downstaging to transplant with a safe washoutIn vivo CAR-T against solid-tumour antigensKeep a freshly removed tumour alive on a pump and test drugs in itKidney and liver impairment dosing studies completed before approval, not years afterLink bariatric and GLP-1 registries to cancer registries in every country that has bothMechanically pulverise one tumour with ultrasound to wake the immune systemMinimum alcohol pricing evaluated with cancer endpointsReplace six-monthly ultrasound with a blood test for liver cancer in cirrhosisTreat everyone with chronic hepatitis B to prevent liver cancer

collections

2
CSCO guidelines (China)Japanese oncology guidelines (JSMO, JSCO and organ societies)

people

8
Alan P. VenookAudre LordeHo Yeong LimMiriam MeradSung-Gyu LeeTheodore S. HongTheodore S. LawrenceThomas U. Marron

bottlenecks

6
Funding follows fashion, not burdenMost lethal cancers are found lateMost of the world has almost no cancer carePain relief and palliative care are unavailable to mostPrevention we already have is not deployedTrials do not represent the people who get cancer

key papers

3
Alcohol caused an estimated 741,000 cancers worldwide in 2020IARC verdict: excess body fat causes 13 cancersIMbrave150: atezolizumab plus bevacizumab replaces sorafenib as first treatment for advanced liver cancer