Effect of ramucirumab on ALBI grade in patients with advanced HCC: Results from REACH and REACH-2

•In patients with HCC, the severity of coexisting liver dysfunction is usually categorised using the Child-Pugh system.•We demonstrate that the simpler albumin–bilirubin (ALBI) nomogram can be used for pre-treatment prognostication and on-treatment assessment.•Ramucirumab did not negatively impact on liver function compared to placebo in patients with advanced HCC and elevated AFP.•Liver-specific adverse events were reported more frequently in patients with more severe liver disfunction at baseline.•Ramucirumab provided a survival benefit irrespective of baseline liver function in patients with advanced HCC and elevated AFP.