What Gastroenterologists Need to Know About New Guidelines on Systemic HCC Therapy

Nancy S. Reau, MD


April 29, 2022

A Relative Lack of Second-Line Data

What are the areas of systemic therapy management that need more data or guidance?

Although treatment decisions in the first-line setting have become clear for most patients, there is still a need for more data to guide treatment selection in the second-line setting.

In the first-line setting, atezolizumab and bevacizumab was shown to provide better overall survival compared with sorafenib. This combination is also the preferred treatment for most patients, with sorafenib and lenvatinib as alternatives in those with contraindications to atezolizumab and bevacizumab.

However, in the second-line setting, multiple therapies have demonstrated superiority to placebo, with no head-to-head comparisons to demonstrate superiority of one agent over the others. Further, all second-line therapies were evaluated after sorafenib, so no therapy has specifically been evaluated after atezolizumab and bevacizumab.

Ideally, we would identify treatment response biomarkers that could help identify which patients will have the best response to specific therapies, which could then be used to tailor treatment choices to optimize outcomes.

In the interim, this is an area where real-world studies may help provide some insight into clinical outcomes.

What are the key takeaway messages of this guideline for clinicians?

There are three. First, although systemic therapy is typically prescribed and managed by medical oncology, it is essential for gastroenterologists and hepatologists to also understand therapeutic options.

Second, although atezolizumab and bevacizumab provides the best overall survival and is the preferred therapy for most patients in the

And third, the AGA guidelines provide recommendations on a population basis, although individual decisions in practice must incorporate specific clinical nuances that are unique to that patient as well as patient preferences.

Nancy S. Reau, MD, is chief of the hepatology section at Rush University Medical Center in Chicago and a regular contributor to Medscape. She serves as editor of Clinical Liver Disease, a multimedia review journal, and recently as a member of HCVGuidelines.org, a web-based resource from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America, as well as educational chair of the AASLD hepatitis C special interest group. She continues to have an active role in the hepatology interest group of the World Gastroenterology Organisation and the American Liver Foundation at the regional and national levels.

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