PURPOSE To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with advanced hepatocellular carcinoma (HCC). METHODS ASCO convened an Expert Panel to conduct a systematic review of published phase III randomized controlled trials (2007-2020) on systemic therapy for advanced HCC and provide recommended care options for this patient population. RESULTS Nine phase III randomized controlled trials met the inclusion criteria. RECOMMENDATIONS Atezolizumab + bevacizumab (atezo + bev) may be offered as first-line treatment of most patients with advanced HCC, Child-Pugh class A liver disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1, and following management of esophageal varices, when present, according to institutional guidelines. Where there are contraindications to atezolizumab and/or bevacizumab, tyrosine kinase inhibitors sorafenib or lenvatinib may be offered as first-line treatment of patients with advanced HCC, Child-Pugh class A liver disease, and ECOG PS 0-1. Following first-line treatment with atezo + bev, and until better data are available, second-line therapy with a tyrosine kinase inhibitor may be recommended for appropriate candidates. Following first-line therapy with sorafenib or lenvatinib, second-line therapy options for appropriate candidates include cabozantinib, regorafenib for patients who previously tolerated sorafenib, or ramucirumab (for patients with α-fetoprotein ≥ 400 ng/mL), or atezo + bev where patients did not have access to this option as first-line therapy. Pembrolizumab or nivolumab are also reasonable options for appropriate patients following sorafenib or lenvatinib. Consideration of nivolumab + ipilimumab as an option for second-line therapy and third-line therapy is discussed. Further guidance on choosing between therapy options is included within the guideline. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines .

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The 69th World Health Assembly endorsed the Global Health Sector Strategy for Viral Hepatitis, embracing a goal to eliminate hepatitis infection as a public health threat by 2030. This was followed by the World Health Organization's (WHO) global targets for the care and management of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. These announcements and targets were important in raising awareness and calling for action; however, tracking countries’ progress towards these elimination goals has provided insights to the limitations of these targets. The existing targets compare a country's progress relative to its 2015 values, penalizing countries who started their programmes prior to 2015, countries with a young population, or countries with a low prevalence. We recommend that (1) WHO simplify the hepatitis elimination targets, (2) change to absolute targets and (3) allow countries to achieve these disease targets with their own service coverage initiatives that will have the maximum impact. The recommended targets are as follows: reduce HCV new chronic cases to ≤5 per 100 000, reduce HBV prevalence among 1‐year‐olds to ≤0.1%, reduce HBV and HCV mortality to ≤5 per 100 000, and demonstrate HBV and HCV year‐to‐year decrease in new HCV‐ and HBV‐related HCC cases. The objective of our recommendations is not to lower expectations or diminish the hepatitis elimination standards, but to provide clearer targets that recognize the past and current elimination efforts by countries, help measure progress towards true elimination, and motivate other countries to follow suit.

LiveWell Initiative LWI, a self funded nonprofit social enterprise (www.livewellng.org) has, for 5 years, supervised MPH and DrPH Practicums for the Harvard T. H. Chan School of Public Health, Harvard University, Boston USA. It also supervises PhD thesis at University of Helsinki, Finland. The organization has repurposed quinine for use in moderate to severe coronavirus disease (COVID-19) by compiling three sets of STUDY PROTOCOLS in response to the COVID-19 RESPONSE with a goal to arriving at a practical and affordable solution to the pandemic. The protocols underwent debates and hypothesis testing among physicians, researchers, pharmacists and virologists. The protocols, still undergoing random Physician–Patient Trials at the discretion of prescribing clinicians and clinical researchers, are as recommended in a compilation of recent findings by LiveWell Initiative LWI on COVID-19. It is a study protocol designed to ‘evolve’ as a solution to COVID-19 response. The protocols strongly suggest the use of quinine for COVID-19 treatment in moderate to advanced disease, recommending intravenous infusion of quinine for critical care in COVID-19. The sample size in a preliminary study, though small, points at quinine for severe COVID-19. Further studies are recommended but the result of this preliminary study is significant. The preliminary results were positive, and were posted online even as the concurrent study continues. The 4-aminoquinolines have the same characteristic effects on the coronavirus, and quinine is the potential COVID-19 eradication tool. In conclusion, quinine is impactful with positive outcomes for severe or advanced COVID-19 especially after the cytokine storm, with 5-7 days total recovery after the onset of the cytokine storm. Due to small preliminary sample size with 100% positive outcome, a full study should be commissioned to establish and quantify the impact of quinine on thousands in a population. This will help to prevent further morbidity in COVID-19 and the cytokine storm will be greatly overcome.