AGA Clinical Practice Guideline on Systemic Therapy for Hepatocellular Carcinoma

Grace L. Su, Osama Altayar, Robert O'Shea, Raj Shah, Bassam Estfan, Candice Wenzell, Shahnaz Sultan, Yngve Falck-Ytter

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background & Aims: Hepatocellular carcinoma (HCC), the most common primary liver cancer, remains a deadly cancer, with an incidence that has tripled in the United States since 1980. In recent years, new systemic therapies for HCC have been approved and a critical assessment of the existing data is necessary to balance benefits and harms and inform the development of evidence-based guidelines. Methods: The American Gastroenterological Association formed a multidisciplinary group consisting of a Technical Review Panel and a Guideline Panel. The Technical Review Panel prioritized clinical questions and outcomes according to their importance for clinicians and patients and conducted an evidence review of systemic therapies in patients with advanced-stage HCC. The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess evidence. The Guideline Panel reviewed the evidence and used the Evidence-to-Decision Framework to develop recommendations. Results: The Panel reviewed the evidence, summarized in the Technical Review, for the following medications approved by the US Food and Drug Administration for HCC: first-line therapies: bevacizumab+atezolizumab, sorafenib, and lenvatinib; second-line therapies: cabozantinib, pembrolizumab, ramucirumab, and regorafenib; and other agents: bevacizumab, nivolumab, and nivolumab+ipilimumab. Conclusions: The Panel agreed on 11 recommendations focused on systemic therapy for HCC in patients who are not eligible for locoregional therapy or resection, those with metastatic disease and preserved liver function, those with poor liver function, and those on systemic therapy as adjuvant therapy.

Original languageEnglish (US)
Pages (from-to)920-934
Number of pages15
JournalGastroenterology
Volume162
Issue number3
DOIs
StatePublished - Mar 2022

Bibliographical note

Funding Information:
Funding Development of this guideline (and the accompanying Technical Review) 5 was fully funded by the AGA Institute without any additional outside funding.

Publisher Copyright:
© 2022

Keywords

  • Hepatocellular Carcinoma
  • Liver Cancer
  • Systemic Therapy

PubMed: MeSH publication types

  • Journal Article
  • Practice Guideline
  • Research Support, Non-U.S. Gov't

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