As with bevacizumab and sorafenib, resistance to anti-VEGF therapy with ramucirumab is often thought to result from an escape mechanism of the angiogenic process through the activation of pathways other than the VEGF pathway [233], although the evidence according to the mechanisms of resistance acquisition for ramucirumab in HCC and other cancer types is limited. Here, VEGFA is linked to hepatocellular carcinoma.