Debating Frontline Choice for Child-Pugh A BCLC-C Bulky Disease

In the first debate round of this Cancer Network Face Off on advanced hepatocellular carcinoma (HCC), moderator Rachna T. Shroff, MD, presents a patient with Child-Pugh A, BCLC stage C disease and bulky tumor burden, asking each team to defend a frontline regimen. Team Deep-Dish Pizza argues for tremelimumab plus durvalumab, citing the favorable ALBI grade 2 subgroup, the 5-year survival tail with roughly 20% of patients alive, comparable time to response, and the convenience of every-four-week durvalumab dosing without continuous anti-VEGF therapy. Team Chicago Hot Dog argues for atezolizumab plus bevacizumab, emphasizing the rapid disease control and robust 30% objective response rate that bulky, higher-burden tumors require, along with the immediate separation of survival curves. Both teams acknowledge that the regimens are reasonable options, framing the choice around patient-specific factors such as tumor burden, urgency of response, and treatment burden in advanced HCC.