Modified BRICS sequential regimen in advanced hepatocellular carcinoma patients with BCLC C stage: a real-world study

Patients with advanced hepatocellular carcinoma (HCC) have limited treatment options and poor prognosis. This study evaluates the efficacy and safety of a modified BRICS (Bifidobacterium-based probiotics, Radiotherapy, Immunotherapy, and anti-angiogenic therapy with a Stereotactic approach) sequential regimen in a real-world setting. In this retrospective study, 22 patients with advanced HCC (BCLC stage C) received the modified BRICS regimen, which included stereotactic body radiotherapy (SBRT) to a single lesion, high-dose probiotics, anti-PD-1 immunotherapy, and anti-angiogenic agents. Efficacy endpoints included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Safety was assessed per NCI-CTCAE v4.0. The ORR was 59.1% (95% CI: 36.4–79.3%), and DCR was 100%. Median PFS and OS were 9.5 months (95% CI: 7.78–11.22) and 22.4 months (95% CI: 8.24–36.57), respectively. Patients with <2 metastatic organs had significantly better outcomes (median PFS: 10.5 vs. 3.8 months; median OS: 26.4 vs. 5.2 months). Grade 3–4 adverse events occurred in only 4.5% of patients, with no treatment-related deaths. The modified BRICS regimen demonstrated promising efficacy and favorable safety in advanced HCC, particularly in patients with limited metastatic burden. These findings support further investigation of multimodal sequential therapy in larger prospective studies.