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

Inclusion Criteria:

1. Clinical diagnosis of HCC.

2. Age between 18 and 75 years;

3. The maximum tumor size ≥10 cm;

4. Intermediate-advanced huge HCC, advanced HCC with PVTT type I-III

5. limited metastases (≤5).

6. Child-Pugh class A or B;

7. Eastern Cooperative Group performance status (ECOG) score of 0-1;

8. 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 ≤ 1.5or PT/APTT within normal limits Absolute neutrophil count (ANC) >1,500/mm3

9. Prothrombin time ≤18s or international normalized ratio < 1.7.

10. Ability to understand the protocol and to agree to and sign a written informedconsent document.

Exclusion Criteria:

1. Diffuse HCC;

2. Extrahepatic metastasis >5;

3. Obstructive PVTT involving mesenteric vena cava (PVTT IV).

4. Serious medical comorbidities.

5. Evidence of hepatic decompensation including ascites, gastrointestinal bleeding orhepatic encephalopathy

6. untreated or incompletely treated esophageal or gastric varices (assessed withesophagogastroduodenoscopy) with bleeding or high risk of bleeding.

7. Eastern Cooperative Group performance status (ECOG) score of ≥2;

8. Known or suspected allergy to the investigational agents or any agent given inassociation with this trial.

9. Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy

10. Evidence of bleeding diathesis.

11. Patients with clinically significant gastrointestinal bleeding within 30 days priorto study entry.