This protocol addresses hepatocellular carcinoma presenting as a localized tumor confined to the liver in patients who do not have underlying cirrhosis — a distinct clinical scenario in which treatment selection differs from cirrhosis-related HCC.
Clinical scenario: Localized HCC confined to the liver; no cirrhosis present. In this setting, surgical resection is the curative treatment of choice. Patients who undergo resection and are considered at high risk of recurrence represent a specific population for whom additional management is indicated.
For patients at high risk of recurrence following liver resection, the protocol includes adjuvant immune checkpoint inhibitor-based systemic therapy initiated in the post-surgical period. Specific eligibility criteria, the timing of therapy initiation relative to surgery, and the full treatment course are detailed in the structured regimen.
Complete protocol details — including patient selection, initiation window, and duration — are available below.
DOI: 10.1097/HEP.0000000000000466
Surgical resection is the curative treatment of choice for patients with localized HCC in the absence of cirrhosis.
Surgical resection should be the treatment of choice for localized HCC in the absence of underlying cirrhosis (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.
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