Complete Response After One Cycle of Atezolizumab Plus Bevacizumab in Advanced Hepatocellular Carcinoma: Two High-Risk Contexts, Child-Pugh Class B and Advanced Age

Complete responses after one cycle of atezolizumab-bevacizumab have been described, but evidence in two high-risk contexts - patients with Child-Pugh class B liver function and very old adults - is scarce. We report two illustrative cases of advanced hepatocellular carcinoma where radiographic complete response was observed after a single treatment cycle. Case 1 involved a patient with Child-Pugh class B liver function; Case 2 involved an older adult. For both cases, we summarize baseline characteristics, serial imaging, and tumor-marker trajectories that corroborate response after minimal exposure to therapy. Radiologic responses were assessed on multiphasic contrast-enhanced CT according to mRECIST; tumor-marker declines supported but did not determine the classification. These two cases do not establish efficacy or safety in these populations; rather, they are descriptive observations showing that such responses can occasionally occur after one treatment cycle and should be interpreted with appropriate caution. Given limited data and safety considerations in Child-Pugh class B and very old patients, the findings should not be generalized without further validation.