Debating Locoregional Versus Earlier Systemic Therapy in BCLC-B HCC

In the third debate round of this Cancer Network Face Off on advanced hepatocellular carcinoma (HCC), moderator Rachna T. Shroff, MD, presents a Child-Pugh A, BCLC stage B patient eligible for locoregional therapy, asking whether clinicians should prioritize locoregional treatment or introduce systemic therapy earlier. Team Deep-Dish Pizza argues for prioritizing locoregional or interventional radiology–directed management first when feasible, noting that intermediate-stage disease is heterogeneous and that overall survival data for added systemic therapy remain immature. Team Chicago Hot Dog argues for earlier systemic therapy in bulky disease with preserved liver reserve, citing the progression-free survival benefit from EMERALD-1 and the risk that patients may not get a second chance at systemic treatment. The panel previews the EMERALD-3 trial, then reading out at ASCO 2026, and the EMERALD yttrium-90 study, agreeing that maturing data will continue to reshape sequencing decisions in intermediate-stage advanced HCC.