Amit Mahipal, MD

An expert discusses how first-line (1L) systemic therapy for unresectable hepatocellular carcinoma (uHCC) has evolved significantly from sorafenib monotherapy to include combination approaches such as atezolizumab plus bevacizumab, which demonstrated superior outcomes in the IMbrave150 trial. Key challenges include underlying liver dysfunction, heterogeneous tumor biology, and managing adverse events while preserving quality of life. Treatment goals focus on extending survival while maintaining liver function and performance status. The shift toward immunotherapy-based combinations has improved outcomes, though patient selection and sequencing strategies remain important considerations in optimizing first-line treatment decisions in clinical practice.

An expert discusses the patient case of a 57-year-old woman diagnosed with advanced unresectable hepatocellular carcinoma. The patient presented with abdominal pain, fatigue, and loss of appetite. She also has a history of Crohn disease, which is being controlled with infliximab. The patient also has a history of variceal bleeding and has been treated with antiviral therapy for chronic hepatitis B virus infection.