Upper GI: HCC - BCLC staging and systemic therapy

Why E is correct

For advanced (BCLC C) hepatocellular carcinoma in a candidate for systemic therapy with Child-Pugh A liver function and ECOG performance status 0-1, the ESMO guideline recommends first-line atezolizumab plus bevacizumab, which demonstrated a significant overall survival benefit over sorafenib (IMbrave150 HR for death 0.66). Varices should be screened for and managed before starting bevacizumab, which this patient has had.

And why the others are not

• ASorafenib was the comparator that atezolizumab plus bevacizumab outperformed; it is no longer the preferred first-line option where the combination is suitable.
• BTACE is the treatment for intermediate-stage (BCLC B) disease confined to the liver, not for BCLC C disease with extrahepatic spread and vascular invasion.
• CLiver transplantation is a curative option for early-stage (BCLC 0/A) disease within criteria; extrahepatic metastasis and vascular invasion are absolute contraindications.
• DRadiofrequency ablation is an early-stage (BCLC 0/A) curative modality, inappropriate for multifocal disease with vascular invasion and extrahepatic metastasis.

Source ESMO Clinical Practice Guideline - Hepatocellular carcinoma (diagnosis, treatment and follow-up) — Vogel A, Martinelli E, et al; ESMO Guidelines Committee. Updated treatment recommendations for hepatocellular carcinoma (HCC) from the ESMO Clinical Practice Guidelines. Ann Oncol. 2021;32(6):801-805.