Non-surgical management of advanced hepatocellular carcinoma: A systematic review by Cancer Care Ontario

Abstract

BACKGROUND: Hepatocellular carcinoma (HCC) is a global health problem, accounting for 4.7% of all new cancer cases and 8.2% of all cancer deaths worldwide in 2018. Resection and transplantation are the only modalities that offer a cure for HCC; however, most patients are diagnosed at an advanced stage, precluding these curative treatments. A number of local (ie, ablative therapies) and/or local-regional therapies (ie, chemo-embolization) are used and followed by systemic therapy for advanced or progressive disease. Other treatments are available, but their efficacy compared with these standards is not well known. METHODS: Literature searches (1/2000 to 1/2020 or 1/2005 to 1/2020, depending on the specific systematic review question) were conducted, including MEDLINE, Embase and the Cochrane Database of Systematic Reviews. RESULTS: Over 30,000 articles were identified. In total, 49 studies were included in the systematic review. CONCLUSIONS: There is no evidence to support the addition of sorafenib to any local or regional therapy. First-line systemic therapy options for unresectable or metastatic HCC include sorafenib, lenvatinib, and atezolizumab + bevacizumab. Regorafenib or cabozantinib provide survival benefits when given as second-line treatment.

Anticancer Drugs Compared to No Anticancer Drugs in Patients with Advanced Hepatobiliary Cancer: A Mapping Review and Evidence Gap Map

“…Sixty studies assessed patients with advanced liver cancer, including 17 SRs, [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] 27 RCTs, 16,17, two RCT protocols 69,70 and 14 observational studies. [71][72][73][74][75][76][77][78][79][80][81][82][83][84] Table 1 provides the characteristics of the included studies.…”

Yttrium-90 Microspheres for Intermediate- or Advanced-Stage Hepatocellular Carcinoma

“…In addition, Cancer Care Ontario is in the process of updating guidelines regarding the non-surgical management of advanced hepatocellular carcinoma. 37 Findings from the NICE appraisal and the Cancer Care Ontario guidelines, as well as additional data from new clinical trials and other evidence syntheses, may help better define the role of 90 Y microspheres in the care pathway.…”

Dose Consideration of Lenvatinib’s Anti-Cancer Effect on Hepatocellular Carcinoma and the Potential Benefit of Combined Colchicine Therapy

“…Lenvatinib is an approved first-line oral multikinase molecular inhibitor for the treatment of advanced hepatocellular carcinoma (HCC) [1]. The anti-cancer mechanisms of lenvatinib include suppression of vascular endothelial growth factor receptor (VEGFR) 1-3, fibroblast growth factor receptor (FGFR) 1-4, platelet-derived growth factor receptor (PDGFR) α, as well as proto-oncogenes RET and KIT expressions [2][3][4].…”