First-line systemic therapy for hepatocellular carcinoma: new options

Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver, originating from hepatocytes. HCC ranks as the sixth most frequently diagnosed cancer globally and the third leading cause of cancer-related mortality [1]. The management of HCC requires a comprehensive, multidisciplinary approach, which includes locoregional therapies, surgical intervention, liver transplantation, as well as systemic therapy for advanced forms of the disease. Contemporary, comprehensive management of HCC patients is inconceivable without collaboration with gastroenterologists and infectious disease specialists. For many years, the pharmacological treatment of advanced hepatocellular carcinoma posed a significant challenge in clinical oncology. Due to the rapid advancement of oncological therapeutics, several highly effective first-line treatment options are now available for unresectable and advanced HCC. This article reviews the current approach to selecting first-line treatment regimens for unresectable HCC, with a particular focus on the combination immunotherapy of durvalumab and tremelimumab, which has been incorporated into updated clinical guidelines. Furthermore, the practical experience of two clinics of specialized types of medical care (Oncology) in utilizing the tremelimumab and durvalumab combination in the first-line setting is described.