Different First-line Immunotherapy for Advancer Hepatocellular Carcinoma: A Prospective Observational Study on Efficacy and Immune Microenvironment

Prior treatment

• Prior systemic therapy for HCC

Other illness

• Active autoimmune disease requiring immunosuppression.
• Active infection requiring IV antibiotics.
• HIV-positive or active HBV/HCV infection (HBsAg+ with HBV DNA ≥2000 IU/mL; HCV RNA+).
• Any condition compromising protocol compliance or data interpretation per investigator.

Other

• Symptomatic CNS metastases.
• Pregnancy/lactation.

• Age ≥ 18 years at time of study entry.
• Barcelona Clinic Liver Cancer stage C, or stage B not amenable to curative or locoregional therapies.
• HCC confirmed by radiology, histology or cytology.
• No prior systemic therapy for HCC.
• At least one measurable site of disease as defined by RECIST1.1criteria with spiral CT scan or MRI.
• Child-Pugh scores 5-7, performance status (PS) ≤ 2 (ECOG scale).
• Adequate organ function:
  • ANC ≥1.5 × 10⁹/L, platelets ≥100 × 10⁹/L, hemoglobin ≥9 g/dL.
  • Total bilirubin ≤1.5 × ULN, AST/ALT ≤3 × ULN (≤5 × ULN if liver metastases).
  • Creatinine ≤1.5 × ULN or CrCl ≥60 mL/min.
• Willing to provide archival/fresh tumor tissue and peripheral blood samples.
• Signed informed consent.