Cabozantinib for advanced hepatocellular carcinoma

Results of the phase III CELESTIAL trial of cabozantinib were recently reported in the New England Journal of Medicine (1). Whereas all preceding clinical trials examining second-line agents ended in failure (2-7), the CELESTIAL trial succeeded, and cabozantinib has become the fourth molecular-targeted agent for hepatocellular carcinoma (HCC). This success was followed by another clinical trial of ramucirumab, the success of which was reported at the American Society of Clinical Oncology meeting in June 2018. As a result, two first-line agents, sorafenib and lenvatinib (8), and three second-line agents, regorafenib, cabozantinib, and ramucirumab, are now available for the treatment of HCC.