Systemic therapies for patients with advanced hepatocellular carcinoma (HCC) are limited, with only sorafenib approved as a first-line agent. Lenvatinib, an inhibitor of VEGFR1–3, PDFGRα, FGFR1–4, RET and KIT, had previously shown activity against HCC in a phase II trial. In an open-label, phase III, multicentre non-inferiority trial in patients with unresectable, untreated HCC (n = 954), Kudo et al. found that there was no difference in overall survival (OS) between those given sorafenib (median OS 12.3 months, 95% CI 10.4–13.9) or lenvatinib (median OS 13.6 months, 95% CI 12.1–14.9). Lenvatinib was also associated with longer median progression-free survival and median time-to-progression than sorafenib.