New Therapies and Potential Biomarkers for Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the second leading cause of cancer mortality in the world. Sorafenib is the only first-line systemic therapy for HCC. HCC is an immunogenic cancer that might be treatable with immune checkpoint inhibitors as single agents or in combination; options could include anti-CTLA-4 agents (eg, tremelimumab), anti-PD-1 agents (eg, nivolumab, pembrolizumab), and anti-PD-L1 agents (eg, atezolizumab). Beyond immune checkpoint inhibitors, potentially useful treatments for HCC include immune modulator (lenalidomide), multikinase inhibitor (regorafenib), and monoclonal antibody (ramucirumab). At least 3 biomarkers in HCC can predict prognosis and suggest potential benefits to therapy: AFP, C-MET, and PD-L1. At high values or when overexpressed, these biomarkers indicate poor prognosis of HCC, yet such markers also point to better response to specific therapies. For instance, AFP >400 may indicate a patient population that would especially benefit from anti-angiogenic agent ramucirumab.