For patients with Hepatocellular Carcinoma (HCC) the options are limited. Caught early enough RadioFrequency Ablation (RFC), TransArterial ChemoEmbolisation (TACE) or surgical resection can potentially be curative. For some patients with advanced disease a liver transplant may be an option, but what about everyone else?

Up until recently, Sorafanib was the mainstay of treatment and the only real option to slow down the progression of the HCC and give patients some extra months or years of time. Nivolumab (Opdivo) appeared in 2017 but remains prohibitively expensive for most patients.

A couple of months ago the New England Journal of Medicine published the Phase 3 results for Cabozantinib which has been shown to work where patients are failing Sorafenib.

https://www.nejm.org/doi/full/10.1056/NEJMoa1717002

Although it's not a cure it can add some precious time. While it is anecdotal, back in 2015, I had a patient who was failing Sorafenib and was rejected from this very trial having been fully worked up. He was shattered and asked for help. Given this drug was, at the time, very experimental we went through an extensive informed consent process, including enlisting the assistance of his oncologist who said "We really don't have much to lose..." As it turned out he did very well on the Cabozantinib and got  2 extra years of good quality life.

It's not a cure, but it does provide cause for hope, as we inch ever closer to more effective treatments for HCC.