Pexastimogene devacirepvec is under development for the first line treatment of advanced hepatocellular carcinoma. The drug is an engineered virus with a gene that promotes the body’s natural response to cancerous cells in the liver. This treatment is administered by injection directly into the cancerous cells in the liver or through the veins. It is designed to selectively target and destroy cancer cells through three different ways: direct destruction of the cancer cells, reduction of the blood supply to tumours and the stimulation of the body’s defense against cancer cells. If licensed, pexastimogene devacirepvec may offer an additional treatment option for patients. Currently, there are few treatment options for advanced hepatocellular carcinoma patients, with only one drug, sorafenib, approved for the first line treatment of advanced hepatocellular carcinoma.