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Publications

Journal Article Review Epublish 1 citation

PubMed: 42819747 DOI: 10.1016/j.lanepe.2026.101839

Systemic treatment paradigms for unresectable and advanced hepatocellular carcinoma in Europe.

Lancet Reg Health Eur 70:101839

Authors: David J Pinato, Eleonora Alimenti, Pasquale Lombardi, Juan Vaz, Antonia Digklia, Julien Edeline, Najib Ben Khaled, Emanuela Di Giacomo, Bernhard Scheiner, Jose Presa Ramos, Grainne M O'Kane, Sarah Cappuyns, Giulia Tesini, Lorenza Rimassa

Affiliations

  • Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Du Cane Road, London, W120NN, UK.
  • Department of Translational Medicine (DIMET), University of Piemonte Orientale "A. Avogadro", Novara, Italy.
  • Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Du Cane Road, London, W120NN, UK. Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy.
  • Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
  • School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • University Hospital of Lausanne, Lausanne, Switzerland.
  • Medical Oncology, Centre Eugène Marquis, Rennes, France.
  • Department of Medicine II, University Hospital, LMU Munich, Munich, Germany.
  • Operative Research Unit of Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
  • Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
  • Liver Unit, Internal Medicine Department, ULSTMAD, Vila Real, Portugal.
  • St. Vincent's University Hospital and University College Dublin, Dublin, Ireland.
  • Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, Du Cane Road, London, W120NN, UK. Digestive Oncology, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.
  • Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • Hepatopancreatobiliary Oncology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.

Abstract

The management of unresectable and advanced hepatocellular carcinoma (HCC) has been transformed by the introduction of immune checkpoint inhibitor-based combinations, which have improved response and survival and expanded first-line treatment options. The availability of multiple effective regimens has introduced new challenges in therapeutic decision making. In the absence of validated predictive biomarkers or head-to-head comparisons, first-line treatment selection remains largely guided by clinical characteristics, contraindications and anticipated toxicity, while the optimal sequencing of therapy following first-line immunotherapy remains uncertain. Locoregional therapies continue to play an important role in selected patients with liver-confined disease, further broadening the range of therapeutic strategies available in clinical practice. In Europe, these evolving treatment paradigms are implemented within a heterogeneous landscape of regulatory approval, reimbursement and access, resulting in important differences in care across countries. In this Series paper, we discuss contemporary systemic treatment strategies for HCC from a European perspective, focusing on treatment selection and sequencing, the role of predictive biomarkers and locoregional therapies, and disparities in access to effective treatments. Generating prospective evidence to inform treatment selection and sequencing, while ensuring more timely and equitable access to effective therapies will be essential to optimise HCC care across Europe.

MeSH

Carcinoma, Hepatocellular, Biomarkers, Therapeutics