This protocol covers hepatocellular carcinoma in patients with well-compensated liver cirrhosis, where a specific combination of tumor and hepatic characteristics guides the treatment strategy.
The patient has liver cirrhosis — Child-Turcotte-Pugh class A (well-compensated hepatic function) with limited hepatic tumor burden, absence of clinically significant portal hypertension, and an adequate future liver remnant. This profile defines the population for this first-line protocol.
In patients assessed as high risk for recurrence after surgery, the approach includes adjuvant immune checkpoint inhibitor-based systemic therapy — the complete regimen, patient-selection criteria, and treatment timeline are detailed in the full protocol.
In patients with cirrhosis, surgical resection should be considered the treatment of choice for patients with limited tumor burden, well-compensated cirrhosis without clinically significant portal hypertension, and an adequate FLR (Level 2, Strong Recommendation).
AASLD recommends use of adjuvant immune checkpoint inhibitor-based systemic therapy in patients at high risk of recurrence after liver resection or local ablation (Level 2, Strong Recommendation).
Patients randomized to atezolizumab plus bevacizumab were started on therapy within 12 weeks of the surgery and treated for 12 months unless the patient experienced disease recurrence or dose-limiting toxicity.
DOI: 10.1097/HEP.0000000000000466
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