Debating Frontline Treatment for Child-Pugh B7 Disease With Compromised Liver Function

In the second debate round of this Cancer Network Face Off on advanced hepatocellular carcinoma (HCC), moderator Rachna T. Shroff, MD, presents a treatment-naive patient with Child-Pugh B7, BCLC stage C disease and compromised liver function, asking how limited liver reserve should influence frontline selection. Team Chicago Hot Dog argues that atezolizumab plus bevacizumab remains appropriate, pointing to real-world experience in Child-Pugh B7 patients and robust response and survival data supported by strong multidisciplinary management. Team Deep-Dish Pizza emphasizes preserving liver function as a goal distinct from treating the cancer, and expresses comfort using the STRIDE regimen, tremelimumab plus durvalumab, given the real-world ALBI grade 2 data and the SIERRA safety findings. The panel reaches broad consensus that Child-Pugh B7 patients generally have worse outcomes but can still be treated, while acknowledging that mature SIERRA efficacy data are needed to refine this approach in advanced HCC.