Advances in Systemic Therapy for Hepatocellular Carcinoma and Future Prospects

The treatment of hepatocellular carcinoma has shifted significantly from the era of local therapy to the era of drug therapy, partly because of changes in background factors. Drug therapy for hepatocellular carcinoma has made rapid progress in recent years. We have moved from an era where sorafenib monotherapy was used to prolong survival, to an era of sequential therapy with multiple tyrosine kinase inhibitors, and further improvements in patient prognosis have been achieved with the introduction of immunotherapy com-bining atezolizumab and bevacizumab. The availability of highly effective drugs has expanded the range of diseases treatable by drug therapy. Additionally, instead of ini-tiating drug therapy at advanced stages, combining it with local therapies such as transarterial chemoembolization at an earlier stage with the aim of achieving a cure has become possible, improving treatment outcomes further. Currently, the number of regimens requiring consideration, involving combinations of multiple drugs and local therapies, has increased, leading to various trials being conducted. Additionally, cases of hepatocellular carcinoma that were previously unresectable have become resectable after drug therapy, necessitating the establishment of a resectability classification system. This review summarises the current evidence for drug therapy of hepatocellular carcinoma and discusses future treatment strategies, treatment combinations, and prospects.