Systemic therapy for hepatocellular carcinoma.

The prognosis is poor for patients with advanced hepatocellular carcinoma (HCC). Sorafenib is the only accepted standard of care for advanced disease. The benefits of this agent are modest and the precise mechanism of antitumor activity in HCC is unknown. Since the approval of sorafenib, there has been intense investigation into strategies that block angiogenic pathways. Unfortunately, the results of three randomized phase III trials that compared newer anti-angiogenic treatments to sorafenib failed to demonstrate their superiority or non-inferiority. Thus, there remains a critical need for both continued molecular characterization and aggressive drug development in hepatocellular carcinoma.