Would you use bevacizumab in a patient with advanced HCC and multiple large esophageal varices that have not been endosopically intervened upon?

Large varices should be treated endoscopically. I would avoid using Atezo/bev in a patient who has not had adequate treatment of their varices as there is a real risk of bleeding with bev in this setting.

It’s very important to treat varices before initiating bevacizumab in this patient population. Phase 3 trial specifically excluded patients with untreated varices. In the earlier phase 1/2 trial, there were 1-2 deaths secondary to bleeding from untreated varices.