Second line systemic therapy options for advanced hepatocellular carcinoma; a systematic review

This systematic review aims at evaluation of the level of evidence for the use of second-line systemic therapy for patients with hepatocellular carcinoma. Eligible studies were identified using database search. Eligible studies reported efficacy and/or toxicity data for patients with hepatocellular carcinoma receiving second-line systemic chemotherapy. Twenty five studies were eligible and were included in the final analysis. Median progression-free survival was reported in 20 out of the 25 studies and it ranged from 1.8 to 11 months. Median overall survival was reported in 18 out of 25 studies and it ranged from 6.6 months to 16 months. Reported grade 3/4 toxicities were regimen-specific and it includes hepatotoxicity, hypertension, and hematologic toxicities. However, positive results from the use of some agents need further confirmation in prospective studies