Evolving Treatment of Advanced Hepatocellular Carcinoma in the Asia–Pacific Region: A Review and Multidisciplinary Expert Opinion

Abstract

Hepatocellular carcinoma (HCC) is the fourth most common driver of cancer-related death globally, with an estimated 72% of cases in Asia. For more than a decade, first-line systemic treatments for advanced or unresectable HCC were limited to the multi-targeted kinase inhibitors sorafenib and, more recently, lenvatinib. Now, treatment options have expanded to include immunotherapy, as exemplified by the immune checkpoint inhibitor (ICI) atezolizumab combined with the antiangiogenic agent bevacizumab. Additional combinations of ICIs with kinase inhibitors, other ICIs, or antiangiogenic agents are under investigation, further supporting the new era of immunotherapy for first-line treatment of advanced or unresectable HCC. We describe this evolving landscape and provide expert opinion on therapeutic best practices in the Asia–Pacific region, where different costs of, and patient access to, treatment are a challenge. With the combination of atezolizumab plus bevacizumab likely to become the clinical standard of care, optimising treatment sequence and ensuring patient access to newer therapies remain priorities. Cost containment and treatment sequencing may be facilitated by characterisation of predictive positive and negative biomarkers. With these considerations in mind, this review and expert opinion focused on advanced HCC in the Asia–Pacific region offers perspectives of multiple stakeholders, including physicians, payer systems, and patients.

Changing the Treatment Paradigm for Hepatocellular Carcinoma Using Atezolizumab plus Bevacizumab Combination Therapy

“…Atezolizumab plus bevacizumab combination therapy is hypothesized to improve the prognosis of patients with advanced HCC [90][91][92]. In addition, the safety of atezolizumab plus bevacizumab in real-world practice is consistent with that in the phase 3 IMbrave150 trial [90].…”

Chemoembolization for Hepatocellular Carcinoma in Patients With Inferior Vena Caval/Right Atrial Tumor Thrombi Without Hepatic Vein Invasion

“…Standard treatment for HCC with vascular invasion is systemic therapy, such as sorafenib or atezolizumab plus bevacizumab (16). However, in actual practice, some patients with advanced-stage HCC, including those with extrahepatic metastasis, are treated using locoregional treatments, such as chemoembolization, because most patients die of intrahepatic tumor progression (17).…”

Effect of Deletion of ANGPTL4 Gene on Viability, Migration and Invasion Ability and Apoptosis of Hepatocellular Carcinoma Cells

“…Hepatocellular carcinoma (HCC) is a malignancy, accounting for 80% of primary liver cancers [1]. Morbidity and mortality have constantly increased in recent years, with approximately 900,000 new primary liver cancers and 800,000 HCC deaths worldwide, mainly in Southeast Asia [2]. Surgical treatments such as liver resection or liver transplantation are effective in patients with early-stage HCC [3,4].…”