Durable Control of Multi-Refractory HBV-HCC with Bevacizumab/Sintilimab/Lenvatinib Triplet Therapy.

Advanced HCC progressing after standard first-line immune checkpoint inhibitor (ICI)/antiangiogenic therapy and second-line tyrosine kinase inhibitors (TKIs) has limited treatment options. A 67-year-old male with HBV-related HCC (cT2N1M0, Child-Pugh B) exhibited rapid progression after transarterial chemoembolization, bevacizumab/sintilimab, and lenvatinib monotherapy. Salvage triplet therapy with bevacizumab (400 mg IV q3w), sintilimab (200 mg IV q3w), and lenvatinib (8 mg daily) achieved >50% alpha-fetoprotein (AFP) reduction within two cycles and sustained radiologic disease stabilization for 10 months, with only grade 1 fatigue and hemoptysis. This is the first documented case of bevacizumab/sintilimab/lenvatinib triplet efficacy in triple-class refractory HCC, suggesting potential synergistic mechanisms and feasibility even in Child-Pugh B patients. These findings warrant further investigation in prospective studies.