fig2

Figure 2. Evolution of locoregionary and systemic HCC treatment options. Initially, no systemic HCC treatments were available, and the numerous locoregionary therapies either percutaneously (ethanol injection, brachytherapy or radiofrequency ablation) or transcatheter-based methods (TACE or SIRT) were the only alternatives, when liver resection or transplantation were not feasible. In 2007, sorafenib was granted approval as systemic first line HCC treatment. After almost a decade, different first and second line TKI treatment options evolved. Ramucirumab, an anti-VEGFR-2 monoclonal antibody, was the only non-TKI-based systemic second-line treatment available until 2020. Then, for the first, time an immune checkpoint-inhibitor-based treatment (atezolizumab combined with bevacizumab) was granted approval in HCC first line treatment. TACE: Transarterial chemoembolization; SIRT: selective internal radiotherapy; RFA: radiofrequency ablation; OS: overall survival; TKI: tyrosine kinase inhibitor.