Preventing Esophageal Varices in Advanced Liver Cancer Patients on Atezolizumab-Bevacizumab Therapy

This clinical trial investigates the effectiveness of esophageal band ligation as primary prophylaxis against variceal progression in advanced hepatocellular carcinoma (HCC) patients receiving atezolizumab-bevacizumab combination therapy. The study aims to determine whether early intervention with endoscopic banding can reduce the risk of life-threatening variceal bleeding in this high-risk population.

Study Design: This randomized controlled trial will enroll 110 adult patients with compensated liver disease (Child-Pugh A) who are initiating atezolizumab-bevacizumab treatment. Participants will be divided into two arms:

• Intervention Arm: 55 patients with small non-risky esophageal/gastric varices will undergo prophylactic band ligation before starting cancer therapy, with follow-up endoscopies at 3, 5, 9, and 12 months
• Control Arm: 55 patients with no or minimal varices will receive standard surveillance without prophylactic intervention

Primary Outcomes: The research team will evaluate:

1. Rate of esophagogastric varices progression during systemic therapy
2. Effectiveness of band ligation in preventing variceal bleeding

Secondary Outcome: The study will assess whether more frequent endoscopic monitoring can improve bleeding prevention in patients receiving this specific immunotherapy combination.

Rationale: Patients with HCC often have portal hypertension and are at risk for variceal bleeding, which may be exacerbated by bevacizumab's anti-angiogenic effects. This study addresses a critical gap in managing vascular complications during novel cancer therapies.

Exclusion Criteria: The trial excludes patients with decompensated cirrhosis (Child-Pugh C), significant comorbidities, or poor performance status. The research team anticipates completing enrollment and follow-up within approximately 18 months.