Hepatocellular carcinoma (HCC) is prevalent worldwide with suboptimal therapeutic outcomes. The advancement of therapeutic options and the development of new systemic therapies expand the armamentarium to tackle HCC. Treatment options should be provided based on the hierarchy of efficacy in a multidisciplinary perspective, instead of the traditional stage-guided scheme. In advanced HCC, lenvatinib has a comparable efficacy as sorafenib for the first-line therapy of HCC; while regorafenib, cabozantinib, and ramucirumab have been approved as second-line therapy after the failure of sorafenib. Immune checkpoint inhibitor therapy prolongs response rate and survival and enables long-term cure. Atezolizumab plus bevacizumab is superior to sorafenib as the first-line therapy for advanced HCC. Several emerging regimens by the combination of various systemic therapies are currently under clinical trials. Systemic therapy may be used in the neoadjuvant, adjuvant or even as initial therapy for intermediate-stage HCC. The paradigm shift of HCC treatment will improve patient outcomes.

中文翻译：

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肝细胞癌治疗选择的范式转变

肝细胞癌 (HCC) 在世界范围内普遍存在，治疗效果不佳。治疗选择的进步和新系统疗法的开发扩大了治疗 HCC 的设备。治疗选择应基于多学科视角的疗效等级，而不是传统的分期指导方案。在晚期 HCC 中，乐伐替尼作为 HCC 一线治疗的疗效与索拉非尼相当；而瑞戈非尼、卡博替尼和雷莫芦单抗已被批准为索拉非尼失败后的二线治疗。免疫检查点抑制剂治疗可延长反应率和生存期，并实现长期治愈。Atezolizumab加贝伐单抗作为晚期HCC的一线治疗优于索拉非尼。多种系统疗法相结合的几种新兴方案目前正在临床试验中。全身治疗可用于新辅助、辅助甚至作为中期HCC的初始治疗。HCC 治疗的范式转变将改善患者的预后。