dTACE-HAIC Combined With Bevacizumab and Atezolizumab for Huge Hepatocellular Carcinoma

Prior treatment

• Known or suspected allergy to the investigational agents or any agent given in association with this trial.
• Patients with clinically significant gastrointestinal bleeding within 30 days prior to study entry.

Other illness

• Evidence of hepatic decompensation including ascites, gastrointestinal bleeding or hepatic encephalopathy
• untreated or incompletely treated esophageal or gastric varices (assessed with esophagogastroduodenoscopy) with bleeding or high risk of bleeding.
• Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy
• Evidence of bleeding diathesis.

Other

• Diffuse HCC;
• Extrahepatic metastasis \>5;
• Obstructive PVTT involving mesenteric vena cava (PVTT IV).
• Serious medical comorbidities.
• Eastern Cooperative Group performance status (ECOG) score of ≥2;

• Clinical diagnosis of HCC.
• Age between 18 and 75 years;
• The maximum tumor size ≥10 cm;
• Intermediate-advanced huge HCC, advanced HCC with PVTT type I-III
• limited metastases (≤5).
• Child-Pugh class A or B;
• Eastern Cooperative Group performance status (ECOG) score of 0-1;
• Hemoglobin ≥ 8.5 g/dL Total bilirubin ≤ 30mmol/L Serum albumin ≥ 32 g/L ASL and AST ≤ 5 x upper limit of normal Serum creatinine ≤ 1.5 x upper limit of normal INR ≤ 1.5 or PT/APTT within normal limits Absolute neutrophil count (ANC) \>1,500/mm3
• Prothrombin time ≤18s or international normalized ratio \< 1.7.
• Ability to understand the protocol and to agree to and sign a written informed consent document.