Treatment of Advanced Hepatocellular Carcinoma (BCLC Stage C) with Child-Turcotte-Pugh A Cirrhosis
This protocol covers systemic therapy for patients with advanced hepatocellular carcinoma who have preserved liver function, adequate performance status, and no contraindications to systemic agents.
Clinical Scenario
Eligible patients meet all of the following:
- Advanced HCC — BCLC Stage C, or BCLC Stage B not amenable to or progressing after locoregional therapy
- Child-Turcotte-Pugh A cirrhosis
- ECOG performance status 0–1
- No autoimmune disorder; no prior liver transplantation
Treatment Approach
This setting calls for subsequent-line systemic therapy with targeted agents. The protocol specifies which agents are preferred and how AFP level informs the selection — but the full agent list, sequencing, and criteria remain in the structured protocol.
Complete regimen, preferred agents, and decision algorithm available via the link below.
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 cabozantinib or regorafenib (or ramucirumab in patients with AFP ≥ 400 ng/ml) as preferred agents after sorafenib or lenvatinib if patients are not eligible for clinical trials (Level 1, Strong Recommendation).
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