Current role of systemic therapy in transarterial chemotherapy refractory hepatocellular carcinoma patients

Transarterial chemotherapy (TACE) is the standard treatment for patients with intermediate-stage hepatocellular carcinoma (HCC), defined as large, unresectable, or multinodular HCC in patients with good functional performance. The definition of TACE refractoriness is not well established. Generally, TACE refractoriness is defined as an insufficient response after two or more consecutive TACE. An increase in the number of liver lesions, continuously elevated tumor markers, vascular invasion, and extrahepatic spread also suggest TACE refractoriness. Timely switching to systemic therapy for TACE refractoriness should be considered to improve the outcome. Although data are sparse, the combination of anti-angiogenic and immune checkpoint inhibitor therapies shows promise for TACE-refractory patients. In this article, we review the role of systemic therapy in TACE refractory patients with HCC.