Non-Surgical Management of Advanced Hepatocellular Carcinoma

Guideline Objective

The objective of this guideline is to make recommendations regarding the non-surgical treatment of advanced hepatocellular carcinoma (HCC).

Patient Population

These recommendations apply to adults with locally advanced and advanced HCC, Barcelona Clinic Liver Cancer Stage B and higher, who are not suitable for transplant or surgery.

Intended Guideline Users

Intended users of the guideline are clinicians involved in the care of patients who have HCC; specifically, medical oncologists, radiation oncologists, interventional radiologists, hepatologists, and surgical oncologists.

Research Questions

1. What are benefits of other local therapies (transarterial ethanol ablation [TEA], bland transarterial embolization [TAE], radiofrequency ablation [RFA], transarterial radioembolization [TARE], stereotactic body radiation therapy [SBRT] and drug eluting bead transarterial chemoembolization [DEB-TACE]) versus transarterial chemoembolization (TACE)?
2. What is the benefit of the addition of sorafenib to local therapies (TEA, TAE, RFA, TARE, SBRT, TACE, DEB-TACE)
3. What is the benefit of other systemic treatment regimens versus sorafenib?
4. What is the benefit of the eradication of viral hepatitis (HCV and/or HBV) in patients with advanced HCC?
5. What is the benefit of second-line systemic therapy following sorafenib?
6. Is there a survival difference in HCV populations compared with HBV populations compared with non-viral populations when treated with sorafenib?
7. Is there a survival difference in HCV populations compared with HBV populations compared with non-viral populations when treated with TACE, TAE, or TEA?