Hepatocellular carcinoma therapy reference (2026)
Reference snapshot of HCC therapy across early, intermediate, and advanced disease.
Hepatocellular carcinoma therapy in 2026 organises around stage. Early HCC: liver resection or ablation in selected patients with preserved liver function; liver transplant for patients meeting Milan or expanded criteria.
Intermediate HCC: transarterial chemoembolisation (TACE), transarterial radioembolisation (TARE / Y-90), in selected populations combined with systemic therapy.
Advanced HCC systemic: atezolizumab plus bevacizumab is first-line standard for eligible patients, durvalumab plus tremelimumab is an alternative first-line option (particularly for patients with bleeding risk). Second-line options include lenvatinib, sorafenib, regorafenib, cabozantinib, ramucirumab (in patients with elevated AFP), nivolumab plus ipilimumab, and pembrolizumab.
Late-stage pipeline: TIGIT-targeted combinations and additional mechanism classes are reading out. The combination of systemic IO with locoregional therapy is also being formalised in trials.
The diagnostic and surveillance pathway is the addressable-population enabler. HCC surveillance in cirrhosis (ultrasound plus AFP every 6 months) catches earlier disease but uptake is uneven.
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