HCC

Question 1

First-Line Systemic Therapy: Preferred Regimens

Answer 1

Atezolizumab + bevacizumab (Child-Pugh Class A only)

Tremelimumab-actl + durvalumab
usually reserved if contraindication to bev (ie bleeding risk) HIMALAYA trial not yet FDA app

Question 2

First-Line Systemic Therapy: Other Regimens

Answer 2

Sorafenib (Child-Pugh Class A [category 1] or B)

Lenvatinib (Child-Pugh Class A only)

Durvalumab (category 1)
not FDA app-HIMALAYA

Pembrolizumab (category 2B)
FDA acc app if previously treated with sorafenib

Question 3

First-Line Systemic Therapy: Special Circumstances

Answer 3

Child-Pugh Class B only:
Nivolumab
Atezolizumab + bevacizumab

For TMB-H tumors:
Nivolumab + ipilimumab

Question 4

Second Line Therapy: Preferred Regimens

Answer 4

Child-Pugh Class A only:
Regorafenib
Cabozantinib
Lenvatinib

Child-Pugh Class A or B:
Sorafenib

Question 5

Second Line Therapy: Other Regimens

Answer 5

Nivolumab + ipilimumab (Child-Pugh Class A only)

Pembrolizumab (Child-Pugh Class A only)

Question 6

Second Line Therapy: Special Circumstances

Answer 6

Ramucirumab (AFP ≥400 ng/mL and Child-Pugh Class A only)

Nivolumab (Child-Pugh Class B only)

For MSI-H/dMMR tumors:
Dostarlimab-gxly
(single agent-pan tumor approval)

• For RET gene fusion-positive tumors:
Selpercatinib
(Single agent pan-tumor approval)

• For TMB-H tumors:
Nivolumab + ipilimumab
FDA acc app if previously treated with sorafenib