Bevacizumab in Advanced Hepatocellular Carcinoma

Inclusion Criteria: Histologically or cytologically proven HCC or alpha-fetoprotein level > 400 ng/ml together with hypervascular tumor and cirrhosis documented by CT scan or MRI. HCC not amenable to curative treatment (resection, transplantation, percutaneous ablation) Presence of at least one dimensionally measurable target lesion with largest diameter >= 2 cm. No previous chemoembolization, no previous radiotherapy Cancer of the Liver Italian Program (CLIP) score < 4 World Health Organization (WHO) performance status of 2 or less Life expectancy >= 3 months. Age >= 18 years. Adequate hematologic functions (neutrophil count, at least 1500 per cubic millimeter; platelet count, at least 75,000 per cubic millimetre; Hemoglobin, at least 8 g/dl) Adequate liver function (bilirubin, not more than 2 times the upper limit of normal); Adequate renal function (serum creatinine, less than 150 micromol per liter) Adequate coagulation function Written informed consent Exclusion Criteria: Decompensated cirrhosis (Child-Pugh score > 7) CLIP score > 4 Variceal bleeding during the previous 3 months Thromboembolic event during the previous 6 months Medical condition requiring full dose anticoagulation or anti-platelet drugs Abnormal cardiac function with history of ischemic heart disease in the previous 6 months, uncontrolled hypertension, unstable angina, severe cardiac arrhythmia, No brain metastasis, No bone metastasis only Previous or current malignancies at other sites No concomitant antitumor treatment including tamoxifen or somatostatin analogs Unstable systemic diseases or active uncontrolled infections. Patients (male and female) not using effective contraception if of reproductive potential.