Cited by 498Hepatocellular Carcinoma Treatment and PrognosisColorectal Cancer Treatments and StudiesHepatitis B Virus Studies

Molecular pathogenesis and systemic therapies for hepatocellular carcinoma

Open access
Llovet, Josep M., Pinyol, Roser, Kelley, Robin K., El-Khoueiry, Anthony, Reeves, Helen L., Wang, Xin Wei, Gores, Gregory J., Villanueva, Augusto·2022·Nature Cancer

Abstract

Hepatocellular carcinoma (HCC) remains one of the most prevalent and deadliest cancers. The poor outcome associated with HCC is dramatically changing due to the advent of effective systemic therapies. Here we discuss the molecular pathogenesis of HCC, molecular classes and determinants of heterogeneity. In addition, effective single-agent and combination systemic therapies involving immunotherapies as standard of care are analyzed. Finally, we propose a flowchart of sequential therapies, explore mechanisms of resistance and address the need for predictive biomarkers.

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Crossref · 10.1038/s43018-022-00357-2

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174 of 174 references verified0 citation errors · 0 not checkable

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  • Improvements in systemic therapy for advanced hepatocellular carcinoma have not been matched by improved treatment of early-stage disease.

    “However, this remarkable progress in systemic therapy has not been paralleled by improvements in the treatment of early stage HCC, which typically involves administration of therapies with curative intent, such as resection, liver transplantation or local ablation1,2.”

    From Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma (2024) · cites this paper as [2]

    The Introduction describes major advances in systemic therapy, and 'Placing systemic therapies in the context of HCC management' identifies resection, transplantation and ablation as curative options for early-stage HCC. 'Future directions' calls neoadjuvant and adjuvant therapies an unmet need, but the paper does not establish the broader claim that early-stage treatment has not improved. (LLM, conf=0.84)

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  • For advanced HCC, about 10 systemic regimens have shifted median overall survival from 6-8 months to 19-20 months after first-line treatment and 10-14 months after second-line treatment.

    “For patients with advanced-stage HCC, the current availability of ~10 systemic regimens1,2,5,35,40 has resulted in a shift from median OS durations of 6–8 months to 19–20 months after first-line treatment and 10–14 months after second-line treatment (Fig. 4a).”

    From Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma (2024) · cites this paper as [2]

    The paper’s “Current systemic therapies in HCC” section lists eight approved regimens, plus two combinations with recently reported trial results; it does not establish that about ten regimens were available. “Selection of patients and expected outcomes” reports about 19 months’ survival with one first-line combination, but 13–14 months with other first-line treatments and 8–11 months with the second-line treatments it discusses. The first-line trials section reports 7.9 months for placebo, broadly consistent with the claimed earlier baseline, but the paper does not support the stated 10–14-month second-line range or attribute the entire survival shift to the availability of regimens alone. Page numbers were not provided in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Effective systemic therapies, especially immune-checkpoint inhibitors, have substantially improved outcomes for patients with advanced-stage hepatocellular carcinoma.

    “Over the past two decades, the development of effective systemic therapies has substantially improved the outcomes of patients with advanced-stage HCC2–6.”
  • After resection or local ablation, median overall survival exceeds 60 months, but 30-50% of patients have recurrence by 3 years.

    “Despite an impressive median overall survival (OS) beyond 60 months after resection or local ablation, up to 30–50% of patients have disease recurrence at 3 years, often resulting from intrahepatic metastases or de novo tumours arising in the underlying liver pathology1,2.”

    From Adjuvant and neoadjuvant immunotherapies in hepatocellular carcinoma (2024) · cites this paper as [2]

    The ‘Placing systemic therapies in the context of HCC management’ section (page unavailable) identifies resection and ablation as curative options for early-stage HCC, but gives neither median survival after those treatments nor a three-year recurrence rate. Searches for 60-month survival, three-year recurrence, and recurrence after resection or ablation found no passage supporting those figures; the paper’s 30–50% figures refer to other populations or treatments. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 3

  1. [20][Press Release] FDA grants accelerated approval to nivolumab and ipilimumab combination for hepatocellular carcinoma (2020).
  2. [94][Press Release-28/06/2021] Exelixis and Ipsen Announce Cabozantinib in Combination with an Immune Checkpoint Inhibitor Significantly Improved Progression-Free Survival in Phase 3 COSMIC-312 Pivotal Trial in Patients with Previously Untreated Advanced Live
  3. [137][Press Release] Merck Announces KEYTRUDA® (pembrolizumab) Met Primary Endpoint of Overall Survival (OS) in Patients with Advanced Hepatocellular Carcinoma Previously Treated with Sorafenib - Merck.com.

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Authors
Llovet, J. M., Pinyol, R., Kelley, R. K., El-Khoueiry, A., Reeves, H. L., Wang, X. W., Gores, G. J., & Villanueva, A.
Affiliations
  • Institució Catalana de Recerca i Estudis Avançats (ES)
  • Hospital Clínic de Barcelona (ES)
  • University of California, San Francisco (US)
  • University of Southern California (US)
  • Freeman Hospital (GB)
  • National Cancer Institute (US)
  • Mayo Clinic (US)
  • Tisch Cancer Institute (US)
Corresponding author
Llovet, Josep M.
Venue
Nature Cancer
Published
2022-04-28
Volume
3
Issue
4
Pages
386-401
ISSN
2662-1347 (ISSN-L)
OpenAlex
W4225146220
Cited by
498
References
174
Citations by year
2026: 90 · 2025: 145 · 2024: 157 · 2023: 92 · 2022: 14
FWCI
17.90
Type
journal article
Language
en
Open access
Locations
  • Nature Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Cancer Research UK (26813)
  • National Institutes of Health
  • National Cancer Institute (Z01BC010313, Z01BC010876, Z01BC010877, ZIABC011870)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R56DK056621, R01DK056621, R01DK128289)
Topics
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
  • Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
Keywords
hepatocellular carcinoma, molecular pathogenesis, tumor heterogeneity, systemic therapy, immunotherapy, combination therapy, treatment resistance, predictive biomarkers, sequential therapy, patient selection, patient monitoring
MeSH terms
Combined Modality Therapy, Carcinoma, Hepatocellular, Humans, Immunotherapy, Liver Neoplasms, Molecular Targeted Therapy

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