The incidence of hepatocellular carcinoma (HCC) is increasing in Switzerland and its treatment is a challenge. The purpose of this article is to summarize the different therapeutic approaches in the metastatic stage, as well as the perspectives of targeted treatments and immunotherapy. Until recently, the only recognized therapeutic standard for these patients with metastatic CHC was sorafenib, a tyrosine kinase inhibitor. If the patient was to progress under sorafenib, no other recognized therapeutic option was available as second line. We present in this article the recent data on regorafenib, also an inhibitor of tyrosine kinases, the first systemic therapy showing an increase in survival for patients progressing under sorafenib. Then we will discuss promising data and progress made in treatments checkpoints inhibitors and therapies combining local and systematic approaches.