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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