Prof. Josep Llovet and Prof. Stephen L. Chan discuss a very interesting topic about the use of the VEGFR TKIs monotherapy in the treatment of unresectable or advanced HCC in the first-line setting. They will go into details about who can benefit from monotherapy and will share the current guidance on the implementation of the dosing strategies for the management of toxicity in the clinical practice. They discuss first line monotherapy with TKI (lenvatinib or sorafenib) for patients who are not suitable for the treatment with atezo-bev combination (around 20% of the patients) which is the current standard of care. They summarise the HCC patients who are not ideal for this I/O combination such as HCC patients with liver transplantation, high bleeding risk, impaired liver function or severe autoimmune disease. The experts discuss about which patients can benefit from TKI and provide a summary of efficacy data and safety profile from various pivotal clinical studies (including SHARP, REFLECT, IMbrave150) as well as real-world data. Dosing-strategies for VEGFR-TKIs and management of AEs are discussed as well as guideline recommendations. Finally, the experts discuss key developments over the next few years focusing on the new immunotherapy combinations approach that could become new standard of care.

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