Abstract
Hepatocellular carcinoma (HCC) remains the most prevalent primary liver cancer, characterized by alarmingly high mortality rates and low five-year survival outcomes. A significant challenge in HCC management lies in its advanced-stage treatment, with most cases identified at advanced, unresectable stages, resulting in poor prognoses and limited treatment options. Over the last decade, considerable advancements have been made in systemic treatment strategies, notably with the introduction of multi-kinase inhibitors such as sorafenib and lenvatinib, which have redefined the therapeutic landscape for advanced HCC. The emergence of immunotherapy has further revolutionized first-line treatment, bringing new hope with agents like the PD-1 inhibitor nivolumab and the CTLA-4 inhibitor tremelimumab. Moreover, combination regimens such as atezolizumab plus bevacizumab have demonstrated remarkable clinical efficacy, leading to substantial improvements in overall survival and progression-free survival. Despite the availability of multiple treatment options, clinical trial outcomes remain suboptimal. Key challenges persist in the selection and sequencing of therapies, the development of more diversified combination strategies, and the implementation of downstaging approaches for advanced HCC. This paper aims to provide a comprehensive review of the current progress in systemic therapies for HCC, drawing on extensive research findings and clinical trial data to assess their clinical applications and explore potential challenges. By offering a critical analysis of these therapeutic strategies, this paper seeks to furnish valuable insights and references for ongoing research and future clinical practice, ultimately contributing to improved outcomes in HCC management.