Hepatocellular carcinoma remains a serious global disease. Its incidence is 
increasing. Standard procedures have been developed for each stage. The 
complexity of this disease shows that the selection of patients in stage 0/A for 
different types of surgical treatment is very complicated. Treatment methods of 
stage B, especially locoregional treatment represented by TACE (transarterial 
chemoembolization or radioembolization of TARE), radiofrequency ablation and 
others, move freely to lower and higher stages as adjunctive therapy. Lenvatinib 
can replace TACE with equal efficacy in cases where locoregional treatment 
cannot be used. Until 2016, the only systemic treatment option for stage C was 
sorafenib. Lenvatinib became a second-line drug to show non-inferiority to 
sorafenib in OS. Retrospective analyzes revealed that patients who responded to 
the treatment with lenvatinib or sorafenib had a median survival of over 22 
months. Sequential treatment with sorafenib and regorafenib in the RESOURCE 
study with a median survival of more than 24 months was similar. Ramucirumab was 
effective only in patients with high AFP levels. The study demonstrated the 
importance of selecting patients according to prognostic factors (extrahepatic 
spread and vascular invasion). Second-line cabozantinib has shown the same 
benefit as regorafenib. In the second line, immunotherapy represented by anti 
PD-1 antibodies nivolumab and pembrolizumab was used. Sequential administration 
after sorafenib prolonged the median overall survival of about 22 months. We 
currently have sorafenib and lenvatinib in the first line, regorafenib, 
cabozantinib, ramucirumab (AFP 400 &#956;g/L), pembrolizumab and nivolumab in 
the second line. The possibilities of monotherapy have been exhausted. The 
discovery of a synergistic effect of angiogenesis inhibitors, which convert a 
cold tumor into a hot one and facilitate the efficacy of anti-PD-1 / anti-PDL-1 
antibodies, has led to a highly effective combination therapy. In study 
IMbrave150, the combination of atezolizumab and bevacizumab was successfully 
used compared to sorafenib in the first-line treatment. Additional studies are 
currently underway using other tyrosin kinase inhibitors - regorafenib, 
lenvatinib and cabozantinib - in combination with nivolumab, ipilimumab and 
pembrolizumab. This development of treatment at all stages evoked with renewed 
urgency the need to find a suitable way to search for the early stages of HCC 
and to create a more effective system for selecting patients for the most 
appropriate treatment.