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Advanced HCC — RACP Adult Medicine MCQ

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HardGastroenterologyAdvanced HCCRACP Adult Medicine

A 65-year-old man with hepatitis B cirrhosis (Child-Pugh B) has multifocal HCC (5 lesions, largest 8 cm) with portal vein thrombosis/invasion and lung metastases. ECOG PS is 1. What is the most appropriate management?

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Correct answer: D — Sorafenib

Advanced HCC (BCLC stage C: vascular invasion and/or extrahepatic spread) with preserved performance status is managed with systemic therapy. First-line treatment is now atezolizumab + bevacizumab (IMbrave150 trial). Sorafenib (or lenvatinib) is used if immunotherapy is contraindicated. Transplant and resection are not appropriate for advanced disease.

Reference: Cancer Council Australia – 2024 – HCC; AASLD 2023