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. 2019 Sep 23;10(1):43–80. doi: 10.1016/j.jceh.2019.09.007
Consensus statements Level Grade
  • Sorafenib is recommended as a first line treatment for:
    • Advanced HCC (BCLC C)
    • Intermediate stage HCC (BCLC-B) with preserved liver function (child A; selected child B), not suitable for or progressing despite loco regional therapy.
I Strong
  • Sorafenib is not recommended:
    • As neo-adjuvant or adjuvant therapy with resection
    • As neo-adjuvant or adjuvant therapy with LT
    • As bridging therapy for patients on transplant wait list
    • As a down staging therapy either alone or in combination with LRT
II-1 Strong
  • Sorafenib in combination with local ablative therapies increases the time to progression and has acceptable safety profile but has not shown overall survival benefit; hence, it is not recommended at present, till more data emerges.

I Weak
  • The optimal dose of sorafenib is 400 mg twice daily with optimal management of adverse effects to improve survival. However, sorafenib should be initiated at reduced dose to minimise the adverse events and increase tolerability.

II-2 Weak
  • Sorafenib should be continued till radiologic progression.

I Strong
  • Lenvatinib is non-inferior to sorafenib and is an alternative first-line therapy for:
    • Advanced HCC (BCLC C)
    • Intermediate stage HCC (BCLC-B) with preserved liver function (child A; selected child B), not suitable for or progressing despite locoregional therapy.
I Strong
  • Regorafenib is recommended as second-line treatment for patients tolerating but progressing on sorafenib with well-preserved liver function (Child-Pugh A class) and good performance status.

I Strong
  • Immune checkpoint inhibitors (like nivolumab and tremelimumab) have shown promising results in phase I and II trials. However, they cannot be recommended for clinical use outside of clinical trials, till more data emerge.

II-2 Weak
  • HCC with PVTT should not be grouped with metastatic HCC because newer therapeutic options have shown promising results in case–control studies.

II-2 Strong
  • Sorafenib therapy marginally improves survival in patients with HCC and PVTT.

I Strong
  • TARE with yttrium-90 may be considered in select patients of advanced HCC with PVTT and good liver function (Child-Pugh A)

II-2 Weak
  • TACE with or without radiotherapy or systemic therapy may be considered an option in segmental PVTT.

II-3 Weak