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Hepatocellular carcinoma (liver cancer): options by country

Sourced options by country plus visit-prep questions for Hepatocellular carcinoma (liver cancer). Each line links to its regulator, HTA, or guideline source. This page maps options; it does not recommend or rank them.

Options mappedSolid tumorLast checked June 2026

What this page does

Maps options by country

It maps sourced options by country alongside diagnosis wording, stage, test results, specialists, and trial-search terms.

What it does not do

Does not choose treatment

It does not rank treatments, recommend a choice, or decide clinical fit.

Where it comes from

Built on trusted sources

Every option links to a trusted regulator, HTA, or guideline source, and the list grows as new sources pass verification.

Information to gather before the next visit

  • Is the tumor surgically removable now, or could any treatment be used to revisit surgical options?
  • Has DNAJB1-PRKACA or another diagnostic marker been tested to confirm fibrolamellar carcinoma?
  • Which fibrolamellar-specific clinical trials are open in the relevant country or referral region?
  • Which U.S. fibrolamellar-specific trials are currently recruiting and appropriate to discuss?

Trial-search terms to discuss

Hepatocellular carcinoma (liver cancer) clinical trial

Options by country

Treatments by country

Regulatory and access status by country, from official sources. It shows what exists and where — not a recommendation.

United States

  • Surgical removal of tumors; systemic therapies used when unresectable or distant spread is present; no standard systemic therapy established by the fetched source[1]Established standard of careDNAJB1-PRKACA fusion is described by the source as present in the vast majority of FLC tumors and as confirmatory testing context; Surgery when disease has not spread beyond the liver or tumors can be surgically removed; systemic therapy context for unresectable disease or distant spread. · Foundation information page; not a regulator or formal national guideline. The page explicitly notes it does not provide medical advice. Confidence/conflicts: Medium confidence for broad treatment framework; no conflicting fetched source. Regulator-level status remains source-pending. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility
  • Surgical removal of tumors; systemic therapies used when unresectable or distant spread is present; no standard systemic therapy established by the fetched source[1]Established standard of careDNAJB1-PRKACA fusion is described by the source as present in the vast majority of FLC tumors and as confirmatory testing context; Surgery when disease has not spread beyond the liver or tumors can be surgically removed; systemic therapy context for unresectable disease or distant spread. · Foundation information page; not a regulator or formal national guideline. The page explicitly notes it does not provide medical advice. Confidence/conflicts: Medium confidence for broad treatment framework; no conflicting fetched source. Regulator-level status remains source-pending. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility
  • Surgical removal of tumors; systemic therapies used when unresectable or distant spread is present; no standard systemic therapy established by the fetched source[1]Established standard of careDNAJB1-PRKACA fusion is described by the source as present in the vast majority of FLC tumors and as confirmatory testing context; Surgery when disease has not spread beyond the liver or tumors can be surgically removed; systemic therapy context for unresectable disease or distant spread. · Foundation information page; not a regulator or formal national guideline. The page explicitly notes it does not provide medical advice. Confidence/conflicts: Medium confidence for broad treatment framework; no conflicting fetched source. Regulator-level status remains source-pending. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility
  • Surgical removal of tumors; systemic therapies used when unresectable or distant spread is present; no standard systemic therapy established by the fetched source[1]Established standard of careDNAJB1-PRKACA fusion is described by the source as present in the vast majority of FLC tumors and as confirmatory testing context; Surgery when disease has not spread beyond the liver or tumors can be surgically removed; systemic therapy context for unresectable disease or distant spread. · Foundation information page; not a regulator or formal national guideline. The page explicitly notes it does not provide medical advice. Confidence/conflicts: Medium confidence for broad treatment framework; no conflicting fetched source. Regulator-level status remains source-pending. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility
  • Surgical removal of tumors; systemic therapies used when unresectable or distant spread is present; no standard systemic therapy established by the fetched source[1]Established standard of careDNAJB1-PRKACA fusion is described by the source as present in the vast majority of FLC tumors and as confirmatory testing context; Surgery when disease has not spread beyond the liver or tumors can be surgically removed; systemic therapy context for unresectable disease or distant spread. · Foundation information page; not a regulator or formal national guideline. The page explicitly notes it does not provide medical advice. Confidence/conflicts: Medium confidence for broad treatment framework; no conflicting fetched source. Regulator-level status remains source-pending. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility
  • Surgical removal of tumors; systemic therapies used when unresectable or distant spread is present; no standard systemic therapy established by the fetched source[1]Established standard of careDNAJB1-PRKACA fusion is described by the source as present in the vast majority of FLC tumors and as confirmatory testing context; Surgery when disease has not spread beyond the liver or tumors can be surgically removed; systemic therapy context for unresectable disease or distant spread. · Foundation information page; not a regulator or formal national guideline. The page explicitly notes it does not provide medical advice. Confidence/conflicts: Medium confidence for broad treatment framework; no conflicting fetched source. Regulator-level status remains source-pending. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility
  • ablation; radiation therapy including stereotactic body radiation therapy context in recurrent disease[2]Standard option (per NCI PDQ)localized HCC; recurrent liver-limited disease without vascular involvement. · NCI PDQ is not a formal guideline or personalized recommendation. Radiation and ablation suitability depend on liver function, lesion size/location/number, prior treatments, and local expertise. Confidence/conflicts: high for NCI treatment-option summary; no eligibility inferred. No conflict identified.
  • atezolizumab (Tecentriq) plus bevacizumab[3]FDA-approvedunresectable or metastatic HCC with no prior systemic therapy. · The fetched label is a 2020 FDA label and states it may not be the latest approved label; current prescribing information should be checked before patient-facing reuse. Bevacizumab-specific risks and suitability are not assessed here. Confidence/conflicts: medium-high; FDA label supports indication but current-label refresh remains needed. No conflict identified.
  • surgical resection; liver transplant[2]Standard option (per NCI PDQ)localized primary liver cancer, including solitary mass or limited small-tumor presentations without major vascular invasion as described by NCI. · NCI PDQ is an evidence summary, not an individualized eligibility rule. NCI notes treatment selection is affected by tumor features, performance status, and functional hepatic reserve. Confidence/conflicts: high for NCI treatment-option summary; no eligibility inferred. No conflict identified.
  • transarterial embolization (TAE) and transcatheter arterial chemoembolization (TACE); systemic therapy context[2]Standard option (per NCI PDQ)locally advanced or metastatic disease not amenable to surgery/locoregional interventions; recurrent disease with extrahepatic disease or vascular involvement. · Category is mapped as supportive/palliative because the queue has no locoregional/interventional-radiology category. TAE/TACE applicability depends on disease distribution, vascular involvement, liver function, and MDT assessment. Confidence/conflicts: medium-high; NCI supports the treatment-option framing but queue category is imperfect for TAE/TACE. No conflict identified.
  • tremelimumab (Imjudo) plus durvalumab[4]FDA-approvedadult unresectable HCC; HIMALAYA population had no prior systemic treatment for HCC. · FDA D.I.S.C.O. approval page summarizes approval and trial context but is not the full prescribing information. Current labels for both agents should be checked before patient-facing reuse. Confidence/conflicts: high for FDA approval notice; full prescribing information not fetched in this finding. No conflict identified.

European Union

  • atezolizumab (Tecentriq) plus bevacizumab[5]EMA authorisedadvanced or unresectable HCC with no prior systemic therapy. · EMA central authorisation does not establish Germany/France reimbursement or hospital formulary access. Bevacizumab suitability and bleeding risk are not assessed by this catalog entry. Confidence/conflicts: high for EMA central indication; member-state reimbursement unverified. No conflict identified.
  • atezolizumab (Tecentriq) plus bevacizumab[6]Approvedpreserved hepatic function / Child-Pugh A in requested reimbursement indication; not eligible for locoregional therapies or failure of one locoregional therapy; no prior systemic therapy; not eligible for or failed locoregional therapy. · HAS page is French HTA/reimbursement context and narrower than AMM. It does not establish eligibility, hospital formulary, or sequencing for an individual patient. Confidence/conflicts: high for France HAS scope; no conflict identified.
  • atezolizumab (Tecentriq) plus bevacizumab[7]ApprovedChild-Pugh A or no cirrhosis subgroup; Child-Pugh B subgroup separately assessed; no prior systemic therapy; advanced or unresectable HCC. · This is a G-BA courtesy translation; only the German version is legally binding. Benefit-assessment language is not the same as individual access, eligibility, or hospital formulary status. Confidence/conflicts: high for G-BA courtesy-translation content; German original legally binding. No conflict identified.
  • durvalumab (Imfinzi) monotherapy[8]EMA authorisedfirst-line advanced or unresectable HCC. · EMA central authorisation does not establish reimbursement. This is a distinct monotherapy indication from the tremelimumab-durvalumab combination. Confidence/conflicts: high for EMA central indication; member-state reimbursement unverified. No conflict identified.
  • durvalumab (Imfinzi) monotherapy[9]G-BA benefit assessmentChild-Pugh A or no liver cirrhosis subgroup; Child-Pugh B subgroup separately assessed; first-line advanced or unresectable HCC. · This is a G-BA courtesy translation; only the German version is legally binding. "Additional benefit not proven" should not be read as no marketing authorisation or no possible access. Confidence/conflicts: high for G-BA courtesy-translation content; German original legally binding. No conflict identified.
  • durvalumab (Imfinzi) plus tremelimumab (Imjudo)[10]HAS reimbursement opinionpreserved hepatic function / Child-Pugh A; ECOG 0 or 1; not eligible for locoregional therapy or failure of one locoregional therapy; first-line advanced or unresectable HCC. · HAS explicitly limits public-funding support to the stated population and notes uncertainty about the precise role versus atezolizumab-bevacizumab. Confidence/conflicts: high for France HAS scope; no conflict identified.
  • durvalumab (Imfinzi) plus tremelimumab (Imjudo)[11]ApprovedChild-Pugh A or no liver cirrhosis subgroup; Child-Pugh B subgroup separately assessed; first-line advanced or unresectable HCC. · This is a G-BA courtesy translation; only the German version is legally binding. "Additional benefit not proven" is not the same as absence of marketing authorisation or absence of availability. Confidence/conflicts: high for G-BA courtesy-translation content; German original legally binding. No conflict identified.
  • nivolumab (Opdivo) plus ipilimumab[12]G-BA benefit assessmentChild-Pugh A or no liver cirrhosis subgroup; Child-Pugh B subgroup separately assessed; first-line unresectable or advanced HCC. · This entry uses G-BA benefit-assessment justification text, not a patient-level recommendation. The document is a courtesy translation; only the German version is legally binding. Confidence/conflicts: medium-high; G-BA justification supports indication/comparator/additional-benefit language, but final resolution source should be added when available. German original legally binding. No conflict identified.
  • sorafenib (Nexavar)[13]EMA authorisedhepatocellular carcinoma; source does not state a line of therapy in the therapeutic-indication line. · EMA central authorisation does not establish country-specific reimbursement or sequencing relative to current immunotherapy options. Confidence/conflicts: high for EMA central indication; sequencing/reimbursement unverified. No conflict identified.
  • tremelimumab (Imjudo) plus durvalumab (Imfinzi)[14]EMA authorisedfirst-line advanced or unresectable HCC. · EMA central authorisation does not establish member-state reimbursement. Imjudo is under additional monitoring on the EMA page. Confidence/conflicts: high for EMA central indication; member-state reimbursement unverified. No conflict identified.

United Kingdom

  • atezolizumab (Tecentriq) plus bevacizumab[15]NICE recommendedChild-Pugh grade A liver impairment; ECOG performance status 0 or 1; no previous systemic treatment. · NICE recommendation includes Child-Pugh, ECOG, and commercial-arrangement conditions. It does not establish devolved/private access outside the NICE context. Confidence/conflicts: high for NICE recommendation; devolved/private access not verified. No conflict identified.
  • durvalumab (Imfinzi) plus tremelimumab (Imjudo)[16]Approveduntreated advanced or unresectable HCC. · NICE recommendation includes a commercial-arrangement condition and is NHS England-context. It does not rank the option for an individual. Confidence/conflicts: high for NICE recommendation; devolved/private access not verified. No conflict identified.
  • lenvatinib (Lenvima)[17]NICE recommendedChild-Pugh grade A liver impairment; ECOG performance status 0 or 1; untreated advanced unresectable HCC. · NICE recommendation includes Child-Pugh, ECOG, and commercial-arrangement conditions. Sequencing relative to newer immunotherapy regimens requires current local review. Confidence/conflicts: high for NICE recommendation; sequencing with newer therapies not established here. No conflict identified.
  • sorafenib (Nexavar)[18]NICE recommendedChild-Pugh grade A liver impairment; advanced HCC. · NICE recommendation includes Child-Pugh and commercial-access conditions. The appraisal predates some newer systemic options, so current sequencing should be checked locally. Confidence/conflicts: high for NICE recommendation; current sequencing with newer options not established here. No conflict identified.

Japan

  • atezolizumab (Tecentriq) plus bevacizumab (Avastin)[19]ApprovedIMbrave150 context: unresectable HCC without prior systemic therapy. · This is a manufacturer announcement citing MHLW approval, not a PMDA/MHLW primary label. Current Japanese label, reimbursement, and sequencing require local confirmation. Confidence/conflicts: medium; MHLW approval is manufacturer-attributed and primary current label not fetched. No conflict identified.
  • cabozantinib malate (Cabometyx)[20]PMDA-approved (Japan)post-chemotherapy unresectable hepatocellular carcinoma. · The PMDA list confirms indication language and approval timing, but not current reimbursement, center-level uptake, or preferred sequencing relative to regorafenib, ramucirumab, lenvatinib, or immunotherapy options. Confidence/conflicts: High for PMDA approval-history confirmation. No reimbursement or utilization claim is made.
  • durvalumab (Imfinzi) plus tremelimumab (Imjudo); durvalumab (Imfinzi) monotherapy[21]Approvedunresectable HCC; HIMALAYA trial context included no prior systemic therapy and ineligibility for locoregional therapy. · This is a manufacturer announcement citing Japanese MHLW approvals, not a regulator-primary label. Current Japanese label, reimbursement, and whether monotherapy or combination is locally preferred require treating-team confirmation. Confidence/conflicts: medium; approval is manufacturer-attributed and primary current label not fetched. No conflict identified.
  • lenvatinib mesilate (Lenvima)[22]PMDA-approved (Japan)unresectable hepatocellular carcinoma. · PMDA English translation is reference material; Japanese original takes precedence. The review report does not establish reimbursement or current sequencing after newer immunotherapy options. Confidence/conflicts: high for PMDA review-report indication; current label/reimbursement not checked. No conflict identified.
  • ramucirumab (Cyramza)[20]PMDA-approved (Japan)serum AFP level greater than 400 ng/mL; post-chemotherapy unresectable hepatocellular carcinoma with AFP >400 ng/mL. · The PMDA entry is disease- and biomarker-specific. It does not by itself establish insurer coverage, current sequencing against other post-progression options, or whether AFP and progression criteria are currently met. Confidence/conflicts: High for PMDA approval-history and AFP-threshold confirmation. No reimbursement or comparative-effectiveness claim is made.
  • regorafenib hydrate (Stivarga)[20]PMDA-approved (Japan)post-chemotherapy unresectable hepatocellular carcinoma. · The approved-drugs list establishes the Japan indication language but does not itself specify prior-agent sequencing, reimbursement, or center-level formulary access. Confidence/conflicts: High for PMDA approval-history confirmation. No claim is made about current reimbursement or preferred sequencing.
  • sorafenib tosylate (Nexavar)[20]PMDA-approved (Japan)unresectable hepatocellular carcinoma. · The approved-drugs list confirms Japanese approval history but does not provide current sequencing, reimbursement, or patient-selection detail against newer immunotherapy and TKI options. Confidence/conflicts: High for Japanese approval-history confirmation from PMDA. No current reimbursement claim is made.

Korea

  • Atezolizumab (Tecentriq) plus bevacizumab (Avastin or biosimilar)[23]ApprovedNot biomarker-selected; HCC systemic therapy in context of locoregional treatment failure/refractoriness or local-treatment unsuitability, as illustrated by HIRA adjudication cases. · HIRA case review is not a full label or complete reimbursement rule. It highlights that objective evidence and multidisciplinary/local-therapy assessment affect reimbursement recognition. Korean-language clinical/reimbursement content needs human review. Confidence/conflicts: Medium for reimbursement-context detail; direct full HIRA criteria and MFDS label remain gaps. Korean-language source requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.
  • Atezolizumab (Tecentriq) plus bevacizumab (Avastin or biosimilar)[23]ApprovedNot biomarker-selected; HCC systemic therapy in context of locoregional treatment failure/refractoriness or local-treatment unsuitability, as illustrated by HIRA adjudication cases. · HIRA case review is not a full label or complete reimbursement rule. It highlights that objective evidence and multidisciplinary/local-therapy assessment affect reimbursement recognition. Korean-language clinical/reimbursement content needs human review. Confidence/conflicts: Medium for reimbursement-context detail; direct full HIRA criteria and MFDS label remain gaps. Korean-language source requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.
  • Durvalumab (Imfinzi) plus tremelimumab (Imjudo)[24]MFDS-approved (Korea)Not biomarker-selected; HCC immunotherapy combination context; source describes it alongside first-line HCC treatment options but does not provide full label text. · This is Korean medical-news reporting, not a direct MFDS/HIRA label or final reimbursement notice. Treat approval and reimbursement status as needing primary-source confirmation before patient-facing display. Confidence/conflicts: Medium; direct MFDS and HIRA primary records source-pending. Korean-language text requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.
  • Durvalumab (Imfinzi) plus tremelimumab (Imjudo)[24]MFDS-approved (Korea)Not biomarker-selected; HCC immunotherapy combination context; source describes it alongside first-line HCC treatment options but does not provide full label text. · This is Korean medical-news reporting, not a direct MFDS/HIRA label or final reimbursement notice. Treat approval and reimbursement status as needing primary-source confirmation before patient-facing display. Confidence/conflicts: Medium; direct MFDS and HIRA primary records source-pending. Korean-language text requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.
  • Multidisciplinary local-treatment assessment including TACE, TARE, RFA, SBRT, radiation therapy, and systemic-therapy transition decisions[23]HIRA reimbursementNot biomarker-selected; Transition point from locoregional therapy to systemic therapy or combined symptom-directed approaches in HCC reimbursement adjudication. · This is reimbursement adjudication context, not a universal treatment guideline. It should be used to prompt discussion of documentation and local feasibility, not to infer eligibility. Confidence/conflicts: Medium-high for HIRA reimbursement-case criteria; not a direct clinical eligibility rule. Korean-language source requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.
  • Multidisciplinary local-treatment assessment including TACE, TARE, RFA, SBRT, radiation therapy, and systemic-therapy transition decisions[23]HIRA reimbursementNot biomarker-selected; Transition point from locoregional therapy to systemic therapy or combined symptom-directed approaches in HCC reimbursement adjudication. · This is reimbursement adjudication context, not a universal treatment guideline. It should be used to prompt discussion of documentation and local feasibility, not to infer eligibility. Confidence/conflicts: Medium-high for HIRA reimbursement-case criteria; not a direct clinical eligibility rule. Korean-language source requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.
  • Multidisciplinary local-treatment assessment including TACE, TARE, RFA, SBRT, radiation therapy, and systemic-therapy transition decisions[23]HIRA reimbursementNot biomarker-selected; Transition point from locoregional therapy to systemic therapy or combined symptom-directed approaches in HCC reimbursement adjudication. · This is reimbursement adjudication context, not a universal treatment guideline. It should be used to prompt discussion of documentation and local feasibility, not to infer eligibility. Confidence/conflicts: Medium-high for HIRA reimbursement-case criteria; not a direct clinical eligibility rule. Korean-language source requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.
  • Nivolumab (Opdivo) with ipilimumab (Yervoy)[25]MFDS-approved (Korea)Not biomarker-selected in source; unresectable/metastatic HCC first-line setting; First-line treatment of unresectable or metastatic HCC; CheckMate-9DW context for patients without prior systemic anti-cancer therapy. · Approval announcement is manufacturer-sourced and MFDS-attributed; direct MFDS label and HIRA reimbursement status remain separate. A Korean medical-news source in October 2025 described the need for reimbursement expansion, so approval should not be treated as reimbursed access. Confidence/conflicts: Medium-high for MFDS-attributed approval; reimbursement/access not established and may be limited. Korean-language source requires human review. Primary source is in Korean. English summary pending human review — confirm exact wording with your care team.

Russia

  • Atezolizumab (Tecentriq) plus bevacizumab (Avastin)[26]ApprovedNot biomarker-selected; Preferred first-line systemic therapy for HCC in appropriate patients; previously untreated unresectable HCC per registration report. · Guideline text restricts use by bleeding risk, contraindications to antiangiogenic therapy, performance status, and liver function. The registration report is not the direct State Register page, so the direct GRLS label remains source-pending. Confidence/conflicts: Medium for Russian approval status because direct GRLS label was not fetched; high for guideline-recommended role. Russian-language text requires human review. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team. Availability/reimbursement outside the approving regulator not established.
  • Liver resection, orthotopic liver transplantation, and local ablative methods including radiofrequency or microwave ablation[26]Standard option (per MedElement clinical recommendations portal)Not biomarker-selected; Early/localized HCC; BCLC 0/A and selected BCLC B/C circumstances as described by the guideline. · Selection depends on liver reserve, portal hypertension, transplant criteria, exclusion of extrahepatic spread, and multidisciplinary specialist review. Russian-language clinical content requires human review before patient-facing reuse. Confidence/conflicts: Medium-high for guideline content; direct Ministry-hosted page remains a follow-up gap. Russian-language text requires human review. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team.
  • Liver resection, orthotopic liver transplantation, and local ablative methods including radiofrequency or microwave ablation[26]Standard option (per MedElement clinical recommendations portal)Not biomarker-selected; Early/localized HCC; BCLC 0/A and selected BCLC B/C circumstances as described by the guideline. · Selection depends on liver reserve, portal hypertension, transplant criteria, exclusion of extrahepatic spread, and multidisciplinary specialist review. Russian-language clinical content requires human review before patient-facing reuse. Confidence/conflicts: Medium-high for guideline content; direct Ministry-hosted page remains a follow-up gap. Russian-language text requires human review. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team.
  • Sorafenib, lenvatinib, regorafenib, cabozantinib, ramucirumab[26]Standard option (per MedElement clinical recommendations portal)AFP elevation is relevant only for ramucirumab in the guideline-described later-line setting; First-line alternatives for sorafenib/lenvatinib; later-line options after prior systemic therapy as described by the guideline. · The guideline ties later-line choices to prior treatment, tolerance, liver function, performance status, and AFP level for ramucirumab. Direct Russian product labels and reimbursement status were not fetched for this batch. Confidence/conflicts: Medium-high for guideline-recommended systemic options; direct regulator/reimbursement source-pending. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team.
  • Supportive and background-liver-disease management including antiviral therapy for HBV/HCV, variceal bleeding prophylaxis, and multidisciplinary palliative-specialized treatment[26]Standard option (per MedElement clinical recommendations portal)HBV/HCV status and cirrhosis/varices are relevant supportive-care factors; not tumor biomarkers; Supportive/background-liver-disease care across HCC treatment planning and follow-up. · Supportive measures depend on virology, cirrhosis severity, bleeding risk, and local specialist availability. This is not a substitute for individualized hepatology/oncology management. Confidence/conflicts: Medium-high for guideline-described supportive categories; individual drug access/reimbursement not established. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team.
  • Transarterial chemoembolization (TACE), including superselective techniques, and Y-90 transarterial radioembolization in selected settings[26]Standard option (per MedElement clinical recommendations portal)Not biomarker-selected; Intermediate-stage HCC and selected bridge/downstaging/palliative contexts as described in the guideline. · TACE is not recommended in several high-risk settings such as major vascular invasion/thrombosis, poor liver function, poor performance status, or arteriography contraindications. Decisions are assigned to multidisciplinary and interventional-radiology review. Confidence/conflicts: Medium-high for guideline-recommended locoregional options; local equipment/access and reimbursement are not established. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team.
  • Transarterial chemoembolization (TACE), including superselective techniques, and Y-90 transarterial radioembolization in selected settings[26]Standard option (per MedElement clinical recommendations portal)Not biomarker-selected; Intermediate-stage HCC and selected bridge/downstaging/palliative contexts as described in the guideline. · TACE is not recommended in several high-risk settings such as major vascular invasion/thrombosis, poor liver function, poor performance status, or arteriography contraindications. Decisions are assigned to multidisciplinary and interventional-radiology review. Confidence/conflicts: Medium-high for guideline-recommended locoregional options; local equipment/access and reimbursement are not established. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team.
  • Tremelimumab plus durvalumab; durvalumab monotherapy; nivolumab plus ipilimumab in selected settings[26]Standard option (per MedElement clinical recommendations portal)Not biomarker-selected; First-line systemic therapy options and second/third-line contexts as specified by the guideline. · The guideline notes population limits for the HIMALAYA registration study, including portal-vein-thrombosis exclusions. This entry does not establish Russian regulatory approval or reimbursement for each product; direct GRLS/current-label checks remain needed. Confidence/conflicts: Medium-high for guideline-recommended role; regulatory approval and reimbursement remain source-pending for individual products. Primary source is in Russian. English summary pending human review — confirm exact wording with your care team.

Thailand

  • Atezolizumab (Tecentriq) plus bevacizumab (Avastin)[27]FDA-approvedNot biomarker-selected; Unresectable HCC; no prior systemic therapy. · Thai FDA product record establishes marketing authorization status and indication text, not reimbursement, hospital formulary access, or individual eligibility. Source contains Thai regulatory fields and should receive human review before direct patient-facing reuse. Confidence/conflicts: High for Thai FDA product-record indication and active status; reimbursement not established. Primary source is in Thai. English summary pending human review — confirm exact wording with your care team.
  • Lenvatinib (Lenvat 4)[28]FDA-approvedNot biomarker-selected; Adult advanced or unresectable HCC with no prior systemic therapy. · Thai FDA record establishes a product-record indication and active authorization status, not reimbursement, center stock, or individual eligibility. Source includes Thai regulatory fields and should receive human review. Confidence/conflicts: High for Thai FDA product-record indication and active status; reimbursement not established. Primary source is in Thai. English summary pending human review — confirm exact wording with your care team.
  • Sorafenib (Sorafenat 200)[29]FDA-approvedNot biomarker-selected; HCC not treatable with surgery and local chemotherapy/locoregional chemotherapy according to the Thai product-record text; the page points to liver and bile-duct cancer care guidelines for details. · Thai FDA record is product-specific and does not establish whether this brand is the only available sorafenib product, whether treatment is reimbursed, or whether a patient meets local guideline criteria. Thai-language indication text needs human review. Confidence/conflicts: High for Thai FDA product-record indication and active status; reimbursement and broader brand landscape not established. Primary source is in Thai. English summary pending human review — confirm exact wording with your care team.
  • Tremelimumab (Imjudo) in combination with durvalumab[30]FDA-approvedNot biomarker-selected; Unresectable HCC; line of therapy not further restricted in the Thai FDA product-record excerpt. · Product record is for Imjudo and references combination with durvalumab, but the fetched record is not a full clinical guideline or reimbursement listing. Source contains Thai regulatory fields and should receive human review. Confidence/conflicts: High for Thai FDA Imjudo product-record indication and active status; durvalumab companion label and payer access remain follow-up gaps. Primary source is in Thai. English summary pending human review — confirm exact wording with your care team.

Sources

  1. Fibrolamellar Cancer Foundation — rare-cancer foundation guideline summary · rare-cancer foundation guideline summary
  2. National Cancer Institute (NCI) — national cancer agency evidence summary · national cancer agency evidence summary
  3. U.S. Food and Drug Administration (FDA) — official drug label · official drug label
  4. U.S. Food and Drug Administration (FDA) — regulator approval notice · regulator approval notice
  5. European Medicines Agency (EMA) — regulator EPAR · regulator EPAR
  6. Haute Autorité de Santé (HAS) — national HTA/reimbursement opinion · national HTA/reimbursement opinion
  7. Gemeinsamer Bundesausschuss (G-BA) — national benefit assessment resolution / courtesy translation · national benefit assessment resolution / courtesy translation
  8. European Medicines Agency (EMA) — regulator EPAR · regulator EPAR
  9. Gemeinsamer Bundesausschuss (G-BA) — national benefit assessment resolution / courtesy translation · national benefit assessment resolution / courtesy translation
  10. Haute Autorité de Santé (HAS) — national HTA/reimbursement opinion · national HTA/reimbursement opinion
  11. Gemeinsamer Bundesausschuss (G-BA) — national benefit assessment resolution / courtesy translation · national benefit assessment resolution / courtesy translation
  12. Gemeinsamer Bundesausschuss (G-BA) — national benefit assessment justification / courtesy translation · national benefit assessment justification / courtesy translation
  13. European Medicines Agency (EMA) — regulator EPAR · regulator EPAR
  14. European Medicines Agency (EMA) — regulator EPAR · regulator EPAR
  15. National Institute for Health and Care Excellence (NICE) — national HTA/guideline recommendation · national HTA/guideline recommendation
  16. National Institute for Health and Care Excellence (NICE) — national HTA/guideline recommendation · national HTA/guideline recommendation
  17. National Institute for Health and Care Excellence (NICE) — national HTA/guideline recommendation · national HTA/guideline recommendation
  18. National Institute for Health and Care Excellence (NICE) — national HTA/guideline recommendation · national HTA/guideline recommendation
  19. Chugai Pharmaceutical — manufacturer approval announcement citing MHLW · manufacturer approval announcement citing MHLW
  20. Pharmaceuticals and Medical Devices Agency (PMDA) — regulator approved-drugs list · regulator approved-drugs list
  21. AstraZeneca — manufacturer approval announcement citing Japan MHLW · manufacturer approval announcement citing Japan MHLW
  22. Pharmaceuticals and Medical Devices Agency (PMDA) — regulator review report · regulator review report
  23. Health Insurance Review and Assessment Service (HIRA) — reimbursement adjudication / coverage-criteria case review · reimbursement adjudication / coverage-criteria case review
  24. Medical Times — Korean medical news / regulator and reimbursement context · Korean medical news / regulator and reimbursement context
  25. Ono Pharmaceutical — manufacturer MFDS-attributed approval announcement · manufacturer MFDS-attributed approval announcement
  26. MedElement clinical recommendations portal — Russian clinical guideline mirror / systemic therapy recommendations · Russian clinical guideline mirror / systemic therapy recommendations
  27. Thai Food and Drug Administration / Ministry of Public Health — regulator medicinal-product record · regulator medicinal-product record
  28. Thai Food and Drug Administration / Ministry of Public Health — regulator medicinal-product record · regulator medicinal-product record
  29. Thai Food and Drug Administration / Ministry of Public Health — regulator medicinal-product record · regulator medicinal-product record
  30. Thai Food and Drug Administration / Ministry of Public Health — regulator medicinal-product record · regulator medicinal-product record

This is official regulatory and access status only — not medical advice, not a recommendation, and not a statement about eligibility. Whether any option fits depends on your situation and your oncology team. Status changes over time; confirm the current position with the linked source. Last checked 2026-06-12.

Beyond approved care

In clinical trials & emerging options

Options that are not — or not yet — an approved standard where you live: studies, clinical trials, off-label use, and early evidence that your own oncologist may not raise. Each is labeled by how strong the evidence is. A listing here is information to research and discuss with your team; it does not mean a treatment is proven, safe for you, or available today.

In clinical trials

  • Nivolumab + fluorouracil + recombinant interferon alpha 2b-like protein; DRP-104 + durvalumab; DNAJB1-PRKACA peptide vaccine + nivolumab + ipilimumab; DNAJB1-PRKACA peptide vaccine + DRP-104 + nivolumab + ipilimumab; DT2216 + irinotecanClinical trial · NCT04380545Clinical trialTrial only (NCT04380545)United States · DNAJB1-PRKACA fusion required in some fetched trial records; histologic FLC confirmation required in others; Unresectable fibrolamellar cancer; metastatic or unresectable FLC; advanced-stage FLC; recurrent/refractory fibrolamellar carcinoma in children, adolescents, and young adults depending on the specific trial. · Trials vary by age, prior therapy, molecular confirmation, site, and recruitment status; NCT07430202 was not yet recruiting at the time of the fetched registry record. Confidence/conflicts: High confidence that the fetched registry records support U.S. trial availability/status categories; no conflicting fetched source. FDA approval not established. ClinicalTrials.gov — trial registry
  • Nivolumab + fluorouracil + recombinant interferon alpha 2b-like protein; DRP-104 + durvalumab; DNAJB1-PRKACA peptide vaccine + nivolumab + ipilimumab; DNAJB1-PRKACA peptide vaccine + DRP-104 + nivolumab + ipilimumab; DT2216 + irinotecanClinical trial · NCT04380545Clinical trialTrial only (NCT04380545)United States · DNAJB1-PRKACA fusion required in some fetched trial records; histologic FLC confirmation required in others; Unresectable fibrolamellar cancer; metastatic or unresectable FLC; advanced-stage FLC; recurrent/refractory fibrolamellar carcinoma in children, adolescents, and young adults depending on the specific trial. · Trials vary by age, prior therapy, molecular confirmation, site, and recruitment status; NCT07430202 was not yet recruiting at the time of the fetched registry record. Confidence/conflicts: High confidence that the fetched registry records support U.S. trial availability/status categories; no conflicting fetched source. FDA approval not established. ClinicalTrials.gov — trial registry
  • Nivolumab + fluorouracil + recombinant interferon alpha 2b-like protein; DRP-104 + durvalumab; DNAJB1-PRKACA peptide vaccine + nivolumab + ipilimumab; DNAJB1-PRKACA peptide vaccine + DRP-104 + nivolumab + ipilimumab; DT2216 + irinotecanClinical trial · NCT04380545Clinical trialTrial only (NCT04380545)United States · DNAJB1-PRKACA fusion required in some fetched trial records; histologic FLC confirmation required in others; Unresectable fibrolamellar cancer; metastatic or unresectable FLC; advanced-stage FLC; recurrent/refractory fibrolamellar carcinoma in children, adolescents, and young adults depending on the specific trial. · Trials vary by age, prior therapy, molecular confirmation, site, and recruitment status; NCT07430202 was not yet recruiting at the time of the fetched registry record. Confidence/conflicts: High confidence that the fetched registry records support U.S. trial availability/status categories; no conflicting fetched source. FDA approval not established. ClinicalTrials.gov — trial registry
  • Nivolumab + fluorouracil + recombinant interferon alpha 2b-like protein; DRP-104 + durvalumab; DNAJB1-PRKACA peptide vaccine + nivolumab + ipilimumab; DNAJB1-PRKACA peptide vaccine + DRP-104 + nivolumab + ipilimumab; DT2216 + irinotecanClinical trial · NCT04380545Clinical trialTrial only (NCT04380545)United States · DNAJB1-PRKACA fusion required in some fetched trial records; histologic FLC confirmation required in others; Unresectable fibrolamellar cancer; metastatic or unresectable FLC; advanced-stage FLC; recurrent/refractory fibrolamellar carcinoma in children, adolescents, and young adults depending on the specific trial. · Trials vary by age, prior therapy, molecular confirmation, site, and recruitment status; NCT07430202 was not yet recruiting at the time of the fetched registry record. Confidence/conflicts: High confidence that the fetched registry records support U.S. trial availability/status categories; no conflicting fetched source. FDA approval not established. ClinicalTrials.gov — trial registry
  • Botensilimab + balstilimab; cobolimab + dostarlimabClinical trial · NCT03860272Clinical trialTrial only (registry)European Union · Metastatic or locally advanced solid tumor with no standard therapy available or failed standard therapy for the botensilimab/balstilimab record; pediatric and young adult advanced/metastatic or relapsed/refractory tumor contexts for the cobolimab/dostarlimab record. · Both are broad tumor studies rather than fibrolamellar-only trials; both were active-not-recruiting in fetched records. Confidence/conflicts: High confidence that fetched registry records name fibrolamellar carcinoma and country sites; no conflicting fetched source. Country drug access not established. ClinicalTrials.gov — trial registry
  • Botensilimab + balstilimab; cobolimab + dostarlimabClinical trial · NCT03860272Clinical trialTrial only (registry)European Union · Metastatic or locally advanced solid tumor with no standard therapy available or failed standard therapy for the botensilimab/balstilimab record; pediatric and young adult advanced/metastatic or relapsed/refractory tumor contexts for the cobolimab/dostarlimab record. · Both are broad tumor studies rather than fibrolamellar-only trials; both were active-not-recruiting in fetched records. Confidence/conflicts: High confidence that fetched registry records name fibrolamellar carcinoma and country sites; no conflicting fetched source. Country drug access not established. ClinicalTrials.gov — trial registry
  • Fusion-VAC-XS15 peptide vaccine; sunitinib (Sutent); rare primary liver cancer observational cohortClinical trial · NCT05937295Clinical trialTrial only (registry)European Union · DNAJB1-PRKACA fusion transcript required in German FusionVAC trials; not required by fetched France observational registry text; Germany NCT05937295: locally advanced/metastatic FL-HCC or other DNAJB1-PRKACA fusion cancers; Germany NCT06789198: adjuvant setting after complete remission by surgery, radiotherapy, local therapy, or systemic treatment; France NCT01215565: advanced/inoperable fibrolamellar HCC; France NCT06541652: retrospective observational cohort for rare primary hepatic cancers diagnosed after January 1, 2018. · German studies are investigational vaccine studies; French sunitinib trial is terminated; French rare-liver-cancer cohort is observational and does not assign treatment. Confidence/conflicts: High confidence for fetched registry status and country sites; no conflicting fetched source. EMA/member-state access not established. ClinicalTrials.gov — trial registry
  • Fusion-VAC-XS15 peptide vaccine; sunitinib (Sutent); rare primary liver cancer observational cohortClinical trial · NCT05937295Clinical trialTrial only (registry)European Union · DNAJB1-PRKACA fusion transcript required in German FusionVAC trials; not required by fetched France observational registry text; Germany NCT05937295: locally advanced/metastatic FL-HCC or other DNAJB1-PRKACA fusion cancers; Germany NCT06789198: adjuvant setting after complete remission by surgery, radiotherapy, local therapy, or systemic treatment; France NCT01215565: advanced/inoperable fibrolamellar HCC; France NCT06541652: retrospective observational cohort for rare primary hepatic cancers diagnosed after January 1, 2018. · German studies are investigational vaccine studies; French sunitinib trial is terminated; French rare-liver-cancer cohort is observational and does not assign treatment. Confidence/conflicts: High confidence for fetched registry status and country sites; no conflicting fetched source. EMA/member-state access not established. ClinicalTrials.gov — trial registry
  • Fusion-VAC-XS15 peptide vaccine; sunitinib (Sutent); rare primary liver cancer observational cohortClinical trial · NCT05937295Clinical trialTrial only (registry)European Union · DNAJB1-PRKACA fusion transcript required in German FusionVAC trials; not required by fetched France observational registry text; Germany NCT05937295: locally advanced/metastatic FL-HCC or other DNAJB1-PRKACA fusion cancers; Germany NCT06789198: adjuvant setting after complete remission by surgery, radiotherapy, local therapy, or systemic treatment; France NCT01215565: advanced/inoperable fibrolamellar HCC; France NCT06541652: retrospective observational cohort for rare primary hepatic cancers diagnosed after January 1, 2018. · German studies are investigational vaccine studies; French sunitinib trial is terminated; French rare-liver-cancer cohort is observational and does not assign treatment. Confidence/conflicts: High confidence for fetched registry status and country sites; no conflicting fetched source. EMA/member-state access not established. ClinicalTrials.gov — trial registry
  • Fusion-VAC-XS15 peptide vaccine; sunitinib (Sutent); rare primary liver cancer observational cohortClinical trial · NCT05937295Clinical trialTrial only (registry)European Union · DNAJB1-PRKACA fusion transcript required in German FusionVAC trials; not required by fetched France observational registry text; Germany NCT05937295: locally advanced/metastatic FL-HCC or other DNAJB1-PRKACA fusion cancers; Germany NCT06789198: adjuvant setting after complete remission by surgery, radiotherapy, local therapy, or systemic treatment; France NCT01215565: advanced/inoperable fibrolamellar HCC; France NCT06541652: retrospective observational cohort for rare primary hepatic cancers diagnosed after January 1, 2018. · German studies are investigational vaccine studies; French sunitinib trial is terminated; French rare-liver-cancer cohort is observational and does not assign treatment. Confidence/conflicts: High confidence for fetched registry status and country sites; no conflicting fetched source. EMA/member-state access not established. ClinicalTrials.gov — trial registry
  • Botensilimab + balstilimab; cobolimab + dostarlimabClinical trial · NCT03860272Clinical trialTrial only (registry)United Kingdom · Metastatic or locally advanced solid tumor with no standard therapy available or failed standard therapy for the botensilimab/balstilimab record; pediatric and young adult advanced/metastatic or relapsed/refractory tumor contexts for the cobolimab/dostarlimab record. · Both are broad tumor studies rather than fibrolamellar-only trials; both were active-not-recruiting in fetched records. Confidence/conflicts: High confidence that fetched registry records name fibrolamellar carcinoma and country sites; no conflicting fetched source. Country drug access not established. ClinicalTrials.gov — trial registry
  • Botensilimab + balstilimab; cobolimab + dostarlimabClinical trial · NCT03860272Clinical trialTrial only (registry)United Kingdom · Metastatic or locally advanced solid tumor with no standard therapy available or failed standard therapy for the botensilimab/balstilimab record; pediatric and young adult advanced/metastatic or relapsed/refractory tumor contexts for the cobolimab/dostarlimab record. · Both are broad tumor studies rather than fibrolamellar-only trials; both were active-not-recruiting in fetched records. Confidence/conflicts: High confidence that fetched registry records name fibrolamellar carcinoma and country sites; no conflicting fetched source. Country drug access not established. ClinicalTrials.gov — trial registry
  • KAT-101; KAT-201Clinical trial · NCT05603572Clinical trialTrial only (registry)Korea · HCC not amenable to surgical resection or curative-intent locoregional ablation and not eligible for liver transplantation; registry inclusion text also describes prior/refused/intolerant systemic therapy contexts. · Suspended trial; fibrolamellar carcinoma appears in the condition list, while the summary is broad HCC. Confidence/conflicts: Medium-high confidence for South Korea site and fibrolamellar condition; suspended status and broad HCC framing are important caveats. No conflicting fetched source. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility ClinicalTrials.gov — trial registry
  • KAT-101; KAT-201Clinical trial · NCT05603572Clinical trialTrial only (registry)Korea · HCC not amenable to surgical resection or curative-intent locoregional ablation and not eligible for liver transplantation; registry inclusion text also describes prior/refused/intolerant systemic therapy contexts. · Suspended trial; fibrolamellar carcinoma appears in the condition list, while the summary is broad HCC. Confidence/conflicts: Medium-high confidence for South Korea site and fibrolamellar condition; suspended status and broad HCC framing are important caveats. No conflicting fetched source. reimbursement not established in this jurisdiction trial-registry listing only — does not establish approval, reimbursement, or eligibility ClinicalTrials.gov — trial registry
  • ITGA6-targeting near-infrared II fluorescence image-guided surgery with RD-Cy7 fluorophoreClinical trial · NCT06204835Clinical trialTrial only (NCT06204835)China · ITGA6-targeting investigational imaging context; image-guided surgery study for HCC. · Investigational registry evidence only; not proof of approved surgical imaging availability or eligibility. Trial-specific inclusion criteria and site status must be checked. Confidence/conflicts: high for registry status and China site listing; no approval implied. No conflict identified. ClinicalTrials.gov — clinical-trial registry
  • JS014 plus toripalimab plus TACEClinical trial · NCT06882876Clinical trialTrial only (NCT06882876)China · unresectable HCC. · Registry evidence only; enrolling by invitation is not open general availability. This does not establish routine approval or reimbursement for the combination. Confidence/conflicts: high for registry status and China site listing; no regulatory approval implied. No conflict identified. ClinicalTrials.gov — clinical-trial registry
  • Y-90 selective internal radiation therapy (SIRT)Clinical trial · NCT06707233Clinical trialTrial only (NCT06707233)China · unresectable HCC larger than 7 cm. · Registry evidence only; not proof of routine China availability, reimbursement, or eligibility. Site status should be confirmed directly. Confidence/conflicts: high for registry status and China site listing; no regulatory approval implied. No conflict identified. ClinicalTrials.gov — clinical-trial registry
  • transarterial chemoembolization (TACE) combined with microwave ablation (MWA)Clinical trial · NCT03277716Clinical trialTrial only (NCT03277716)China · unresectable/non-resectable huge HCC; locoregional TACE/MWA study context. · Registry evidence only; overall study status is unknown and site statuses vary. This does not establish NMPA approval, routine availability, reimbursement, or individual eligibility. Confidence/conflicts: medium; registry overall status unknown but China site statuses include recruiting/not-yet-recruiting. No conflict identified. ClinicalTrials.gov — clinical-trial registry
  • atezolizumab (Tecentriq) with lenvatinib (Lenvima) or sorafenib (Nexavar) versus lenvatinib or sorafenib aloneClinical trial · NCT04770896Clinical trialTrial only (NCT04770896)Thailand · unresectable HCC previously treated with atezolizumab plus bevacizumab. · Registry evidence only; not proof of Thai FDA approval, reimbursement, routine availability, or current enrollment. Overall status is active-not-recruiting. Confidence/conflicts: high for registry status and Thailand site listing; no approval or current enrollment implied. No conflict identified. ClinicalTrials.gov — clinical-trial registry
  • cabozantinib plus atezolizumab versus sorafenibClinical trial · NCT03755791Clinical trialTrial only (NCT03755791)Thailand · advanced HCC with no previous systemic anticancer therapy. · Registry evidence only; not proof of Thai FDA approval, reimbursement, routine availability, or current enrollment. Overall status is active-not-recruiting. Confidence/conflicts: high for registry status and Thailand site listing; no approval or current enrollment implied. No conflict identified. ClinicalTrials.gov — clinical-trial registry

A clinical-trial listing or early report shows an option is being studied — not that it works, that it is safe for any one person, or that a site is enrolling today. Whether any of these fits is a conversation for your oncology team and the trial team. Last checked 2026-06-12.