Currently the only predictive biomarker with level 1 evidence (proven by randomized trial (s) designed to test biomarker performance and clinical impact, according to the International Liver Cancer Association (ILCA) white paper [54] is alpha-fetoprotein (AFP) in selecting HCC patients for ramucirumab therapy (an anti-VEGFR antibody) in the second-line setting [55], although its usefulness is limited given the relatively low absolute survival gain by ramucirumab treatment. Here, AFP is linked to hepatocellular carcinoma.