Advanced hepatocellular carcinoma (HCC) has a poor prognosis and limited therapeutic options. Sorafenib (Nexavar®) was the first drug to demonstrate survival benefit. Recently Regorafenib (Stivarga®) proved to be effective as second-line treatment after progression on Sorafenib. Both are only approved in patients with good performance status and preserved liver function. Alternative treatment options with better efficacy and fewer side effects are still an important medical need. Very recently Lenvatinib (Lenvima®) was granted approval as alternative first-line therapy. Cabozantinib and Ramucirumab showed survival benefit compared to placebo, but are not yet available for clinical use. After promising phase I/II trials, phase III studies with other targeted systemic therapies are being performed. Immunotherapy is another challenging research field that is currently being assessed in clinical trials. Nivolumab (Opdivo®) has received accelerated FDA-approval as second-line therapy. Results are further awaited but will influence the care of patients with advanced hepatocellular carcinoma in the near future.

(BELG J MED ONCOL 2018;12(6):287–292)