Nexavar is indicated for the treatment of hepatocellular carcinoma.

NEXAVAR® is indicated for the treatment of patients with unresectable hepatocellular carcinoma (HCC).

Recommendations...First-Line Therapy...Where there are contraindications to atezolizumab and/or bevacizumab, tyrosine kinase inhibitors (TKIs) sorafenib or lenvatinib may be offered as first-line treatment of patients with advanced HCC…Second-Line Therapy...second-line therapy with a TKI (ie, sorafenib, lenvatinib, cabozantinib, or regorafenib) may be recommended...second-line therapy with another TKI (cabozantinib or regorafenib), ramucirumab (AFP ≥ 400 ng/mL)...

Management of advanced disease...Sorafenib is the standard of care for patients with advanced HCC and those with intermediate-stage (BCLC B) disease not eligible for, or progressing despite, locoregional therapies. It is recommended in patients with well-preserved liver function and ECOG PS 0–2 [I, A].

CONTRADICTED EVIDENCE: Management of early and intermediate HCC...The combination of TACE with systemic agents such as sorafenib—either sequential or concomitant—is not recommended in clinical practice [I, E]. Adjuvant therapies... did not improve median recurrence-free survival of HCC patients after LR or local ablation.

CONTRADICTED EVIDENCE: Postoperative Adjuvant Therapy…The panel does not recommend sorafenib as adjuvant therapy.

Sorafenib is recommended as a category 1 option (for selected patients with Child-Pugh class A liver function) and as a category 2A option (for selected patients with Child-Pugh class B7 liver function).

The combination of sorafenib and TACE as postoperative adjuvant therapy in HCC patients with PVTT resulted in longer RFS and OS compared to sorafenib alone and was well tolerated.

Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group (hazard ratio in the sorafenib group, 0.69; 95% confidence interval, 0.55 to 0.87; P<0.001).