Brandon M Meyers1, Jennifer J Knox2, Roxanne Cosby3, J R Beecroft4, Kelvin Kw Chan5, Natalie Coburn5, Jordan J Feld6, Derek Jonker7, Aamer Mahmud8, Jolie Ringash2,9. 1. Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, Ontario, Canada. 2. Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 3. Program in Evidence-Based Care, Department of Oncology, McMaster University, Hamilton, Ontario, Canada. 4. Mount Sinai Hospital, Department of Medical Imaging, Toronto, Ontario, Canada. 5. Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada. 6. Toronto General Hospital Research Institute, Toronto, Ontario, Canada. 7. Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada. 8. Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada. 9. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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.
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.
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