Hepatocellular Carcinoma Clinical Practice Guidelines (AGA, 2022)

Guidelines on the management of hepatocellular carcinoma were published on March 1, 2022, by the American Gastroenterological Association in Gastroenterology.^[1,2]

First-line treatment for HCC in patients with preserved liver function (strength of recommendation, conditional; certainty of evidence, low)

For HCC patients who have preserved liver function not eligible for locoregional therapy (LRT) or resection or who have metastatic disease, atezolizumab+bevacizumab is suggested over sorafenib. (See full AGA Guidelines for more information.)

For HCC patients who have preserved liver function not eligible for LRT or resection or who have metastatic disease and are not candidates for atezolizumab+bevacizumab, lenvatinib or sorafenib is suggested over no systemic therapy. (See full AGA Guidelines for more information.)

Second-line treatment for individuals with disease progression or intolerance to first-line systemic therapy (strength of recommendation, conditional; certainty of evidence, low or very low)

For HCC patients who have preserved liver function not eligible for LRT or resection or who have metastatic disease and have had progression of disease on sorafenib, cabozantinib or pembrolizumab or regorafenib is suggested over no systemic therapy. (See full AGA Guidelines for more information.)

For HCC patients who have preserved liver function and alpha-fetoprotein (AFP) levels >400 ng/mL not eligible for LRT or resection or who have metastatic disease and who have had progression of disease on sorafenib, ramucirumab is suggested over no systemic therapy. In patients with AFP levels <400 ng/mL, the AGA suggests against the use of ramucirumab. (See full AGA Guidelines for more information.)

Systemic therapy for HCC in patients with poor liver function (strength of recommendation, conditional; certainty of evidence, very low)

For HCC patients who have poor liver function not eligible for LRT or resection or who have metastatic disease, the AGA suggests against routine use of sorafenib. (See full AGA Guidelines for more information.)

Systemic therapy for HCC as adjuvant therapy (strength of recommendation, conditional; certainty of evidence, low or very low)

For HCC patients undergoing curative surgical resection or curative local ablation, the AGA suggests against adjuvant sorafenib therapy. (See full AGA Guidelines for more information.)

For HCC patients undergoing TACE (transarterial chemoembolization) LRT, the AGA suggests against adjuvant sorafenib therapy or adjuvant bevacizumab therapy. (See full AGA Guidelines for more information.)

For more information, please go to Hepatocellular Carcinoma.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Hepatocellular Carcinoma Clinical Practice Guidelines (AGA, 2022) - Medscape - Mar 02, 2022.

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