New Systemic Treatment Options for Hepatobiliary Cancers

Multiple systemic therapy options now exist for unresectable and metastatic hepatocellular carcinoma (HCC). Atezolizumab + bevacizumab is the preferred first-line regimen, and although many second-line treatment options have recently been added to the NCCN Guidelines, none have been studied after atezolizumab + bevacizumab (all post-sorafenib), and therefore optimal sequence has yet to be established. Multiple new combination regimens with immune checkpoint inhibitors are also being studied in advanced-stage HCC. In biliary tract cancer (BTC), gemcitabine + cisplatin remains the preferred first-line regimen. FOLFOX is the preferred regimen in the second line. Multiple targeted therapy options are now available in second-line BTC for patients with tumors harboring specific mutations, and these therapeutic targets may guide future treatment sequence and combinations for BTCs.