Systemic Therapy for Advanced Hepatocellular Carcinoma (BCLC Stage C) with Child-Turcotte-Pugh A Cirrhosis

Clinical Scenario

This protocol addresses patients with advanced hepatocellular carcinoma — BCLC Stage C, or BCLC Stage B that is not amenable to locoregional therapy or has progressed after it. The patient has preserved liver function (Child-Turcotte-Pugh A cirrhosis), an ECOG performance status of 0–1, no autoimmune disorder, and no history of liver transplantation.

Key Eligibility Criteria

Advanced HCC: BCLC Stage C, or BCLC Stage B progressing after or not eligible for locoregional therapy
Child-Turcotte-Pugh A cirrhosis (preserved liver function)
ECOG performance status 0–1
No active autoimmune disorder; no prior liver transplantation

Treatment Approach

Second-line systemic therapy in eligible patients centres on multikinase inhibitor therapy as the preferred class of agent. Immunotherapy-based combinations represent an alternative pathway for patients who are not candidates for multikinase inhibition. The complete selection criteria, agent hierarchy, and clinical decision algorithm are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1097/HEP.0000000000000466

Systemic therapy should be offered to patients with preserved liver function (Child-Turcotte-Pugh A or well-selected Child-Turcotte-Pugh B cirrhosis), ECOG PS 0-1, who have BCLC Stage C HCC, or BCLC Stage B HCC not amenable to or progressing after locoregional therapy (Level 1, Strong Recommendation).
AASLD advises second-line therapy in patients with preserved liver function (Child-Turcotte-Pugh A or well-selected Child-Turcotte-Pugh B cirrhosis), ECOG PS 0-1, who develop HCC progression or intolerance with first-line systemic therapy (Level 1, Strong Recommendation).
AASLD advises sorafenib or lenvatinib as preferred agents after first-line atezolizumab plus bevacizumab if patients are not eligible for clinical trials (Level 5, Weak Recommendation).
Cabozantinib, regorafenib, or ipilimumab plus nivolumab may be used in these patients (Level 5, Weak Recommendation).

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