Nonsurgical management of advanced hepatocellular carcinoma: a clinical practice guideline

  • B. M. Meyers Juravinski Cancer CentreDepartment of Oncology, McMaster University
  • J. Knox Princess Margaret Cancer Centre
  • R. Cosby McMaster University
  • J. R. Beecroft Mount Sinai Hospital
  • K. K.W. Chan Sunnybrook Odette Cancer Centre
  • N. Coburn Sunnybrook Odette Cancer Centre
  • J. Feld Toronto General Hospital Research Institute
  • D. Jonker Ottawa Hospital Cancer Centre
  • A. Mahmud Cancer Centre of Southeastern Ontario
  • J. Ringash Princess Margaret Cancer Centre, University of Toronto
Keywords: non-surgical treatment, hepatocellular carcinoma, practice guideline, systemic therapy, tyrosine kinase inhibitor


Background Practice guidelines based on a systematic review of the literature regarding the nonsurgical management of hepatocellular carcinoma (hcc) in North America are lacking. Resection and transplantation are the foundations for cure of hcc; however, most patients are diagnosed at an advanced stage, precluding those curative treatments. A number of local or regional therapies are used and are followed by systemic therapy for advanced or progressive disease. Other treatments are available, but their efficacy, compared with those standards, is not well known.

Methods First, systematic review questions were developed. Literature searches of the medline, embase, and Cochrane library databases (January 2000 to July 2018 or January 2005 to July 2018 depending on the question) were conducted; in addition, abstracts from the 2018 annual meeting of the American Society of Clinical Oncology were reviewed. A practice guideline was drafted that was then scrutinized by internal and external reviewers.

Results Seventy-seven studies were included in the guideline: no guidelines, two systematic reviews, and seventyfive primary studies published in full (including one pooled analysis). Five recommendations were developed.

Conclusions There is no evidence for or against the use of local or regional interventions other than transarterial chemoembolization for the treatment of intermediate- or advanced-stage hcc. Furthermore, there is no evidence to support the addition of sorafenib to any local or regional therapy. Sorafenib or lenvatinib are recommended for firstline systemic treatment of intermediate-stage hcc. Regorafenib or cabozantinib provide survival benefits when given as second-line treatment. Antiviral treatment is recommended in individuals with advanced hcc who are positive for the hepatitis B surface antigen.

Author Biographies

J. R. Beecroft, Mount Sinai Hospital

Medical Imaging

J. Ringash, Princess Margaret Cancer Centre, University of Toronto

Radiation Oncology

How to Cite
Meyers, B. M., Knox, J., Cosby, R., Beecroft, J. R., Chan, K. K., Coburn, N., Feld, J., Jonker, D., Mahmud, A., & Ringash, J. (2019). Nonsurgical management of advanced hepatocellular carcinoma: a clinical practice guideline. Current Oncology, 27(2).
Practice Guideline