HCC, diagnosed mid 2021. Tace procedures on th large tumors in 2021, then on teqcentriq and avastin starting early...

TL;DR:

You've had significant tumor shrinkage with prior treatments, but your kidney function is limiting options. Before accepting "no options remain," get a second opinion at a major cancer center—there are still approaches worth exploring for HCC, especially given your good response history.

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KEY POINTS:

• Your tumor response to Tecentriq + Avastin (15cm→2.5cm, 11cm→2cm) shows your cancer CAN respond to treatment, which is a positive prognostic sign
• Kidney disease (stage 3-4) from Avastin is real and limits some drugs, but doesn't eliminate all HCC treatment pathways
• Tremelimumab + Durvalumab (HIMALAYA regimen) is a standard first-line option, but there are other approaches for patients who don't respond or can't tolerate it
• "Out of options" at one center may not mean out of options at a specialized HCC center—second opinions are critical here
• Clinical trials and less common approaches (locoregional therapy, targeted agents, combination strategies) may still apply to your situation

NEXT STEP: Request your complete imaging and pathology records, then schedule a consultation at an NCCN-designated comprehensive cancer center (like MD Anderson, Memorial Sloan Kettering, or Mayo Clinic) that specializes in HCC—bring your kidney function labs and full treatment history.

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FULL ANSWER

Your Treatment History & Current Situation

You've had a remarkable response to your initial immunotherapy combination (Tecentriq/atezolizumab + Avastin/bevacizumab):

• Tumor shrinkage from 15cm + 11cm down to 2.5cm + 2cm represents a partial response by imaging criteria
• This demonstrates your cancer is biologically responsive to immune-based treatment

However, the cost was significant: Avastin caused kidney injury, progressing your kidney disease to stage 3-4 chronic kidney disease (CKD). This is a known but serious side effect of bevacizumab in HCC patients.

When you transitioned to Tremelimumab + Durvalumab (the HIMALAYA regimen) in November 2025, your team was trying a different immunotherapy approach. The statement that this combination "is not working" (as of February 2026) suggests either:

• Imaging shows tumor growth/progression, OR
• You experienced intolerable side effects

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Is "Out of Options" Accurate? Probably Not.

According to NCCN Guidelines for Hepatocellular Carcinoma (Version 2.2025), when first-line immunotherapy doesn't work or isn't tolerated, there ARE documented second-line and alternative approaches:

1. Other Systemic Therapy Options

The NCCN Guidelines recognize that patients with advanced HCC who progress on or cannot tolerate first-line immunotherapy may be candidates for:

• Sorafenib (a tyrosine kinase inhibitor/TKI) — historically used before immunotherapy became standard, still has a role
• Lenvatinib — another TKI with activity in HCC
• Regorafenib — for patients who progressed on sorafenib
• Cabozantinib — a multi-targeted TKI

Your kidney function matters here: Some of these agents require dose adjustment or monitoring with CKD, but they're not absolutely contraindicated at stage 3-4 kidney disease. Your nephrologist and oncologist would need to co-manage dosing.

2. Locoregional Therapy (Still Relevant)

Even though your tumors have shrunk, locoregional approaches may still apply:

• Transarterial chemoembolization (TACE) — you've had this before; it can be repeated for residual disease
• Stereotactic body radiation therapy (SBRT) — increasingly used for HCC, especially for smaller tumors like your current 2.5cm and 2cm lesions
• Radiofrequency ablation (RFA) or microwave ablation — for smaller, well-defined tumors

According to NCCN Guidelines, SBRT vs. sorafenib was directly compared in the NRG/RTOG 1112 phase III trial (published 2025), showing SBRT may offer benefit for select patients with unresectable HCC.

3. Clinical Trials

This is critical: You may qualify for clinical trials testing:

• Novel immunotherapy combinations
• Targeted agents + immunotherapy
• Metabolic approaches (emerging area)
• Personalized medicine platforms

The webinar resources in my knowledge base mention precision medicine approaches (like TuMatch and BostonGene tumor profiling) that can identify drug combinations tailored to YOUR tumor's specific mutations—these may reveal options your standard team hasn't explored.

4. Kidney Function Considerations

Your stage 3-4 CKD is a real constraint, but it's not a complete barrier:

• Some agents (sorafenib, lenvatinib) can be used with careful monitoring and dose adjustment
• Locoregional therapies (TACE, SBRT, ablation) don't depend on kidney function
• Your nephrologist should be part of the treatment planning conversation

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What "Not Working" Might Mean

Before accepting defeat, clarify with your team:

1. Is this radiographic progression? (Tumors growing on imaging)
2. Is this clinical progression? (Symptoms worsening, liver function declining)
3. Did you have intolerable side effects? (If so, which ones? This changes options)
4. Have they done molecular/genetic testing on your tumor? (Knowing your tumor's mutations—like TERT, TP53, CTNNB1, etc.—can guide targeted therapy)

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Why a Second Opinion Matters

According to NCCN Guidelines, HCC is complex and treatment decisions should ideally involve multidisciplinary teams at centers of expertise. Your situation is:

• Medically complex (HCC + advanced CKD + prior immunotherapy response)
• Potentially still treatable (you have residual disease, not widespread metastases; your prior response shows biology is favorable)
• Requires specialized expertise (kidney-sparing HCC treatment is a subspecialty)

A major HCC center may:

• Recommend SBRT or repeat TACE for your 2.5cm and 2cm tumors
• Propose a TKI with nephrology co-management
• Identify a clinical trial match
• Perform tumor profiling to guide precision medicine

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The Bottom Line

You are NOT out of options. You may be out of options at your current center, or your current team may not have explored all pathways. Your prior response to Tecentriq + Avastin is actually a favorable prognostic sign—it means your tumor is biologically responsive.

Next concrete steps:

1. Get a second opinion at an NCCN-designated comprehensive cancer center specializing in HCC
2. Bring complete records: imaging (CT/MRI), pathology, all lab work including kidney function, and treatment timeline
3. Ask specifically about: SBRT, repeat locoregional therapy, TKI options with nephrology support, and clinical trial eligibility
4. Request tumor molecular testing if not already done (can guide precision medicine approaches)

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Sources Cited

This response is based on:

• NCCN Guidelines for Hepatocellular Carcinoma (Version 2.2025) — specifically sections on systemic therapy options, locoregional therapy, and second-line treatment approaches
• NRG/RTOG 1112 trial (2025) — SBRT vs. sorafenib in HCC, showing SBRT efficacy
• IMbrave150 and HIMALAYA trial data — documenting immunotherapy responses and progression patterns in HCC

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions. Your situation warrants urgent specialist consultation, ideally at a major HCC center.