The European Society for Medical Oncology (ESMO) has issued updated guidance on the treatment of hepatocellular carcinoma (HCC).
The new eUpdate states that, as lenvatinib has now been approved by the European Medicines Agency (EMA) and has demonstrated non-inferior efficacy compared with sorafenib, it can be considered as front-line systemic treatment in patients with advanced HCC without main portal vein invasion and with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0-1.
Regorafenib remains the standard of care for patients with advanced HCC who have tolerated sorafenib but progressed. It is recommended in patients with well-preserved liver function and ECOG PS 0-1.
However, cabozantinib, which received EMA approval in late 2018, can now be considered for patients with disease progression after one or two systemic therapies with well-preserved liver function and ECOG PS 0-1.
Pending EMA approval, ESMO also advises that ramucirumab can be considered as second-line treatment in patients with baseline alpha-fetoprotein (AFP) ≥400 ng/mL, well-preserved liver function and ECOG PS 0-1.
The new recommendations update the 2018 Hepatocellular Carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.