Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

TLDR

The NCCN Guidelines for hepatobiliary cancers provide comprehensive recommendations on screening, diagnosis, staging, and management of HCC, gallbladder cancer, and cholangiocarcinoma, emphasizing multidisciplinary evaluation due to diverse treatment options and liver dysfunction complications, and noting recent advances in systemic therapy beyond sorafenib. The article reviews the NCCN Guidelines recommendations for hepatocellular carcinoma. The guidelines recommend a multidisciplinary team comprising hepatologists, radiologists, interventional radiologists, surgeons, medical oncologists, and pathologists with hepatobiliary expertise. Atezolizumab plus bevacizumab was shown in 2020 to improve survival over sorafenib and became the FDA‑approved frontline regimen for unresectable or metastatic HCC.

Abstract

The NCCN Guidelines for Hepatobiliary Cancers focus on the screening, diagnosis, staging, treatment, and management of hepatocellular carcinoma (HCC), gallbladder cancer, and cancer of the bile ducts (intrahepatic and extrahepatic cholangiocarcinoma). Due to the multiple modalities that can be used to treat the disease and the complications that can arise from comorbid liver dysfunction, a multidisciplinary evaluation is essential for determining an optimal treatment strategy. A multidisciplinary team should include hepatologists, diagnostic radiologists, interventional radiologists, surgeons, medical oncologists, and pathologists with hepatobiliary cancer expertise. In addition to surgery, transplant, and intra-arterial therapies, there have been great advances in the systemic treatment of HCC. Until recently, sorafenib was the only systemic therapy option for patients with advanced HCC. In 2020, the combination of atezolizumab and bevacizumab became the first regimen to show superior survival to sorafenib, gaining it FDA approval as a new frontline standard regimen for unresectable or metastatic HCC. This article discusses the NCCN Guidelines recommendations for HCC.