Treatment for BCLC stage B and C Hepatocellular carcinoma (HCC) has historically been largely liver directed therapy. Although this remains the current mainstay of treatment sorafenib has had an impact on the treatment landscape over the last five to ten years and has been the only systemic option for HCC. Recently second line treatments with regorafenib and with carbozantinib have shown survival advantage against placebo and levatinib has shown non-inferiority to sorafenib in first line treatment. Phase 1/2 studies, after sorafenib using nivolumab (Checkmate 040) and pembrolizumab (Keynote-224) have both shown promising activity against HCC of all common aetiologies. A randomised study in first line systemic therapy for HCC comparing sorafenib with nivolumab in over 700 patients (Checkmate 459) has finished accrual and will soon report on outcomes. It is likely that our treatment pathways and guidelines in at least stage C disease will change in the near future to reflect these newer agents.