Managing High-Risk BCLC-C HCC in a Younger Fit Patient

In the second clinical scenario of this Cancer Network Face Off on advanced hepatocellular carcinoma (HCC), Team Chicago Hot Dog manages a 54-year-old man with NASH-related cirrhosis and BCLC stage C disease, excellent performance status, bulky bilobar disease with a 9.2-cm dominant lesion, Vp3 invasion, two lung metastases, Child-Pugh A5, ALBI grade 1, no varices on recent endoscopy, and a rapidly rising alpha-fetoprotein level. Jun Gong, MD, argues for atezolizumab plus bevacizumab, reasoning that this high-risk, bulky, NASH-associated disease requires the rapid, deep response the combination provides, and noting easier access to endoscopy and toxicity management near an academic center. Other panelists counter that nivolumab plus ipilimumab is also appropriate given the high response and complete response rates and the durable responses seen in CheckMate 9DW, particularly in a motivated, fit patient able to undergo close monitoring for immune-related adverse events during the early high-risk period.