The standard treatment for patients with advanced HCC is systemic therapies. In patients who show low intolerance or disease progression, consider enrolment in clinical trials where available. First-line approved systemic therapy in Australia for advanced HCC is either sorafenib or lenvatinib. Approved second-line therapies for patients who progress on a first-line therapy includes regorafenib, nivolumab and cabozantinib; however, these are currently not reimbursed by the Pharmaceutical Benefits Advisory Committee.

The combination of atezolizumab and bevacizumab is currently submitted to the Pharmaceutical Benefits Advisory Committee for approval (Finn et al. 2020).

Palliation of symptoms may include TACE, surgery, radiation and other therapies.