Treatment of Advanced Hepatocellular Carcinoma with Prior Liver Transplantation or Immunotherapy Contraindication (Child-Turcotte-Pugh A)
This protocol covers first-line systemic management of advanced hepatocellular carcinoma in patients with Child-Turcotte-Pugh A cirrhosis and good performance status, for whom immune checkpoint inhibitor-based regimens are not an option.
Clinical Scenario
- Advanced hepatocellular carcinoma
- Child-Turcotte-Pugh A cirrhosis
- ECOG performance status 0–1
- Contraindication to immunotherapy — severe autoimmune disorder or history of liver transplantation
Treatment Approach
First-Line
When standard immunotherapy-based combinations are contraindicated, a first-line systemic therapy is recommended for eligible patients in this setting. The complete regimen and decision pathway are available in the full protocol.
Full options, evidence levels, and sequencing are in the structured protocol below.
References
DOI: 10.1097/HEP.0000000000000466
- Patients with Child-Turcotte-Pugh A cirrhosis in whom atezolizumab plus bevacizumab and durvalumab plus tremelimumab are contraindicated should be offered first-line sorafenib or lenvatinib (Level 1, Strong Recommendation).
- AASLD advises against the use of ICIs in patients with recurrent HCC after liver transplantation given increased risk of graft loss and death (Level 4, Strong Recommendation).
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