Minireviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2023; 29(10): 1551-1568
Published online Mar 14, 2023. doi: 10.3748/wjg.v29.i10.1551
Systemic treatment for unresectable hepatocellular carcinoma
Wattana Leowattana, Tawithep Leowattana, PathompThep Leowattana
Wattana Leowattana, PathompThep Leowattana, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Tawithep Leowattana, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
Author contributions: Leowattana W wrote the paper; Leowattana T and Leowattana P collected the data.
Conflict-of-interest statement: All the authors report no having relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wattana Leowattana, BMed, MD, MSc, PhD, Full Professor, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi Road, Rachatawee, Bangkok 10400, Thailand. wattana.leo@mahidol.ac.th
Received: September 27, 2022
Peer-review started: September 27, 2022
First decision: January 3, 2023
Revised: January 8, 2023
Accepted: February 22, 2023
Article in press: February 22, 2023
Published online: March 14, 2023
Processing time: 163 Days and 18.9 Hours
Core Tip

Core Tip: Hepatocellular carcinoma (HCC) is a major health problem that is the fourth leading cause of cancer-related mortality worldwide. The 5-year survival rate was nearly 19%, but only 2% in metastatic HCC. The first oral multikinase inhibitor for the systemic treatment of advanced or unresectable HCC (uHCC) was sorafenib. However, when compared to sorafenib, the combination of atezolizumab and bevacizumab increased survival rates and was authorized as first-line treatment for uHCC. Regorafenib and cabozantinib are suggested for use as second-line drugs in the event that the disease progresses. Transarterial chemoembolization for palliative care or downstaging is also suggested. This review focused on systemic therapy for uHCC patients who are not appropriate for liver-directed therapy.