Hepatocellular carcinoma (HCC) ranks among the most common cancers worldwide and remains to be a major global health care problem. Until 2007, no effective therapies were available for patients after failure of locoregional approaches, and the approval of sorafenib as the first systemic agent with efficacy in patients suffering from advanced HCC marked a new era in the treatment of this deadly disease. However, it took nearly 10 years until the portfolio of effective drugs finally expanded and additional substances showed activity in both first and further lines of treatment. Since their recent approval, these novel substances have substantially changed the field of palliative treatment strategies in patients with advanced HCC, and their sequential application has demonstrated their potential to significantly prolong patient survival in the palliative setting. With the recently communicated data from the first positive immuno-oncology trial in HCC, it appears highly likely that the implementation of IO concepts will result in a further improvement of patient prognosis. Although locoregional approaches remain an integral component of meaningful treatment concepts for patients with BCLC-B stage HCC, repetitive interventions bear the risk of a progressive deterioration of liver function. More than ever, in order to implement long-term therapeutic concepts and exploit the full potential of systemic treatment strategies, it is of utmost importance to maintain a fine balance between anti-tumor activity and toxicity. With an emphasis on the systemic treatment options, this review provides a summary of the most recent results from large phase III clinical trials and discusses their clinical implications.

中文翻译：

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当前治疗中晚期肝细胞癌的策略。

肝细胞癌（HCC）是全球最常见的癌症之一，仍然是全球医疗保健的主要问题。直到2007年，局部治疗方法失败后仍没有针对患者的有效疗法，索拉非尼被批准为首个对晚期HCC患者有效的全身性药物，标志着这种致命疾病的治疗新纪元。然而，用了将近10年的时间，有效药物的组合才最终扩大，并且其他物质在第一线和后续治疗中均显示出活性。自从最近获得批准以来，这些新型物质已大大改变了晚期HCC患者的姑息治疗策略领域，并且它们的顺序应用已经证明了其在姑息性环境中显着延长患者存活率的潜力。根据最近在HCC中进行的首次阳性免疫肿瘤试验的最新数据，很可能IO概念的实施将导致患者预后的进一步改善。尽管局部治疗方法仍然是BCLC-B期HCC患者有意义的治疗方案的重要组成部分，但重复性干预仍存在肝功能逐渐恶化的风险。为了实施长期治疗概念并充分利用全身治疗策略的潜力，保持抗肿瘤活性和毒性之间的良好平衡至关重要。着重于全身治疗方案，