Managing Multifocal BCLC-C HCC With Portal Vein Invasion and Variceal History

In the first clinical scenario of this Cancer Network Face Off on advanced hepatocellular carcinoma (HCC), Team Deep-Dish Pizza manages a 67-year-old woman with hepatitis B cirrhosis and BCLC stage C disease, multifocal bilobar tumors with branch portal vein invasion (Vp3), Child-Pugh A6, ALBI grade 2, and an elevated alpha-fetoprotein level. Her history includes medium varices banded 6 weeks earlier, a prior gastric ulcer bleed, type 2 diabetes, chronic kidney disease, and hypertension, and she lives at a distance from the infusion center. The panel begins with multidisciplinary tumor board review, removing curative options given the multifocal disease, and then reasons toward the STRIDE regimen, tremelimumab plus durvalumab. The experts emphasize that the variceal history, gastric ulcer, hypertension, and chronic kidney disease steer them away from anti-VEGF therapy, while the every-four-week dosing better preserves quality of life, illustrating individualized frontline decision-making in higher-risk advanced HCC.