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Hépato-Gastro & Oncologie Digestive

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Intrahepatic multilocular hepatocellular carcinoma with macrovascular extension after failure of atezolizumab + bevacizumab Volume 28, supplement 6, December 2021

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Authors
CHU de Saint-Étienne, Service d’hépato-gastroentérologie et d’oncologie digestive, 42055 Saint-Étienne Cedex 2
* Correspondance

During more than 10 years, sorafenib has remained the only effective systemic therapy for advanced and/or metastatic hepatocellular carcinoma BCLC (Barcelona Clinic Liver Cancer) C. Alternative therapies have been added to the therapeutic arsenal, which is dominated by other tyrosine kinase inhibitors with strong antiangiogenic activity (cabozantinib and regorafenib) and the anti-VEGFR2 antibody, ramucirumab. Each of these three treatments has been compared in Phase III trials to placebo in patients who have failed sorafenib, but with different selection criteria, making difficulties to interpret the results. More recently, the advent of immunotherapy (atezolizumab) associated with an anti-VEGF antibody (bevacizumab) has become the new first line standard in this setting (improved overall survival, progression-free survival and response rates vs. sorafenib in a phase III trial, IMbrave150). Thus, the treatment algorithm has become complex, especially for the choice of the second line of treatment. Exploratory studies and meta-analyses have attempted to define the best options, but national and international recommendations mainly based on the results of phase III trials remain very open about the second-line options that can be considered after failure of atezolizumab + bevacizumab combination.