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eUpdate – Hepatocellular Carcinoma Algorithm

Published: 05 March 2021. Authors: ESMO Guidelines Committee

Note: This eUpdate replaces all previous algorithm eUpdates.

Clinical Practice Guidelines

This eUpdate refers to Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Vogel A, Cervantes A, Chau I et al. Ann Oncol 2018; 29 (Suppl 4): iv238–iv255. 


Figure 1. HCC treatment options depending on BCLC stage

Text update

This eUpdate provides an updated version of Figure 1.


a Non-standard, alternative treatment.
b ESMO-MCBS v1.1 score for new therapy/indication approved by the EMA since 1 January 2016. The score has been calculated by the ESMO-MCBS Working Group and validated by the ESMO Guidelines Committee.
c Non-inferiority to sorafenib established; no evaluable benefit.
d Regorafenib is not recommended in TKI-naive patients.
e Ramucirumab is only recommended in patients with an AFP level ≥ 400 ng/ml.

AFP, α-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; BSC, best supportive care; EMA, European Medicines Agency; HCC, hepatocellular carcinoma; LTX, liver transplantation; MCBS, ESMO-Magnitude of Clinical Benefit Scale; SBRT, stereotactic body radiotherapy; SIRT, selective internal radiotherapy; TACE, transarterial chemoembolisation; TKI, tyrosine kinase inhibitor.

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