OnCo

Hepatocellular carcinoma: lines of therapy

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11 standard-of-care settings across 5 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comers
Screening, prevention and diagnosis2
Early / localised3
Advanced, first line2
Third line and beyond1
Other settings3

Screening, prevention and diagnosis

SubgroupSettingApproachProducts and trialsEvidence
All comersPreventionUniversal HBV vaccination; antiviral suppression of HBV; direct-acting antiviral cure of HCV; alcohol and metabolic risk reduction.89
All comersSurveillanceSix-monthly ultrasound ± AFP in cirrhosis and high-risk HBV carriers; abbreviated MRI where ultrasound is inadequate.40

Early / localised

SubgroupSettingApproachProducts and trialsEvidence
All comersEarlyResection, ablation, transplant.40
All comersVery 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.40
All comersAdjuvant after resection/ablationNo approved adjuvant therapy; IMbrave050 benefit not sustained. Surveillance imaging every 3-6 months.53

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
All comersAdvancedAtezolizumab-bevacizumab, durvalumab-tremelimumab, or nivolumab-ipilimumab.86
All comersAdvanced (BCLC C), first lineAtezolizumab + bevacizumab (IMbrave150), STRIDE tremelimumab + durvalumab (HIMALAYA), or nivolumab + ipilimumab (CheckMate 9DW); lenvatinib or sorafenib if immunotherapy is contraindicated (transplant, active autoimmune disease).95

Third line and beyond

SubgroupSettingApproachProducts and trialsEvidence
All comersAdvanced, second line and beyondAfter immunotherapy: lenvatinib, sorafenib, cabozantinib or regorafenib by extrapolation (no dedicated phase 3); ramucirumab if AFP ≥400 ng/mL; clinical trials.95

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersIntermediateTACE/TARE ± systemic therapy.94
All comersIntermediate (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).78
All comersPortal vein tumour thrombosisSystemic immunotherapy; Y-90 radioembolisation where TACE is contraindicated; radiotherapy to the thrombus in selected patients.40

Sequence and caution pairings

Regimens in the library

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.