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Table 4 Systemic therapies approved for HCC by FDA

From: Emerging treatment modalities for systemic therapy in hepatocellular carcinoma

Agent

Mechanism

FDA-approved indications

First-line

 Sorafenib

Targeting VEGFR, PDGFR, c-KIT, RET, and Ras/Raf/MEK/ERK

As monotherapy in patients with unresectable or metastasis HCC

 Lenvatinib

Targeting VEGFR, PDGFR, FGFR, RET, and SCFR

As monotherapy in patients with unresectable HCC

 Atezolizumab + Bevacizumab

Anti-PD-L1 antibody + Anti-VEGF antibody

For patients with unresectable or metastatic HCC who have not received prior systemic therapy

Second-line

 Regorafenib

Targeting VEGFR, PDGFR, BRAF, FGFR, KIT, and RET

As monotherapy in sorafenib-experienced patients

 Cabozantinib

Targeting VEGFR2, c-MET, AXL, KIT, and RET

As monotherapy in sorafenib-experienced patients

 Ramucirumab

Anti-VEGFR antibody

As monotherapy in sorafenib-experienced patients with AFP of 400 ng/ml or higher

 Nivolumab

Anti-PD-1 antibody

As monotherapy in sorafenib-experienced patients

 Pembrolizumab

Nivolumab + Ipilimumab

Anti-PD-1 antibody

Anti-PD-1 antibody + Anti-CTLA-4 antibody

As monotherapy in sorafenib-experienced patients

As combination therapy in sorafenib-experienced patients