FAQ: What the New BEACON-HCC Framework Changes in HCC Treatment

For nearly 30 years, the Barcelona Clinic Liver Cancer (BCLC) system has helped guide treatment allocation in hepatocellular carcinoma (HCC). But as treatment options have expanded, clinicians increasingly face cases that do not fit neatly into a stage-based treatment pathway.

RELATED: New Liver Cancer BEACON-HCC Framework Shows 96.6% Concordance in Pilot
https://www.hcplive.com/view/liver-cancer-beacon-hcc-framework-shows-96-6-concordance-in-pilot

BEACON-HCC, a new North American consensus framework for HCC treatment allocation, was published August 7, 2026, in Hepatology by the American Association for the Study of Liver Diseases (AASLD) and the HCC-Live Consortium. Developed by 20 experts from 17 cancer centers, the framework was designed to address the increasing complexity of HCC treatment as newer therapies and treatment approaches have expanded beyond traditional treatment pathways.

The framework has drawn attention in part because of its initial validation data: treatment recommendations generated by BEACON-HCC showed 96.6% concordance with expert treatment decisions, compared with 72.4% for the 2025 BCLC framework. But those numbers are only part of the story. The more important question for clinicians is where the 2 frameworks actually differ—and what those differences mean for treatment allocation.

That comparison is particularly relevant because BCLC has not remained static. Its 2026 update incorporated newer treatment options while retaining its stage-based structure and introduced the CUSE framework to help multidisciplinary teams navigate treatment decisions involving greater complexity and uncertainty.

BEACON-HCC is similarly intended to support multidisciplinary decision-making, but it takes a different approach, incorporating more granular tumor and clinical characteristics into treatment allocation.

Frequently Asked Questions

Why was BEACON-HCC developed?

Co-author Mark Yarchoan, MD, of Johns Hopkins, said his team's real-world management of HCC was increasingly diverging from recommendations generated by the BCLC system. BCLC has linked HCC staging with treatment allocation since the late 1990s, but treatment options and multidisciplinary practice have continued to expand.

BEACON-HCC was developed to provide a North American consensus framework that incorporates a broader range of tumor and clinical characteristics into treatment allocation.

Importantly, BCLC itself has continued to evolve. The 2026 BCLC update incorporated newer therapeutic options while retaining its stage-based structure and added the CUSE framework—Complexity, Uncertainty, Subjectivity, and Emotion—to help multidisciplinary teams navigate treatment decisions when evidence does not clearly favor 1 approach.

What is BEACON-HCC intended to be used for?

BEACON-HCC is intended to support multidisciplinary HCC treatment decisions, particularly in cases in which tumor characteristics, liver function, vascular invasion, treatment availability, and patient factors create multiple potential treatment pathways.

The authors describe it as a tool for multidisciplinary discussion rather than a prescriptive algorithm that replaces clinical judgment.

What's the clearest example of where BEACON-HCC and BCLC diverge?

Vascular invasion is 1 of the clearest differences.

BCLC has traditionally classified patients with macrovascular invasion as having advanced HCC, generally directing treatment toward systemic therapy. BEACON-HCC instead considers vascular invasion alongside other tumor and clinical characteristics rather than treating it as an automatic exclusion from curative-intent treatment.

Yarchoan pointed to a Johns Hopkins trial in which selected patients with vascular invasion underwent potentially curative resection as an example of treatment approaches that can fall outside a traditional stage-based treatment pathway.

BEACON-HCC also separates extrahepatic spread from macrovascular invasion and considers the extent of vascular invasion.

What other treatment-allocation differences are there?

The frameworks differ in several areas beyond vascular invasion.

A subsequent Hepatology Viewpoint by Matthew S. Johnson, MD, John H. Holden, MD, and Anita A. Turk, MD, identified several structural differences between the frameworks. These include BEACON-HCC's distinction between solitary and multiple tumors, its consideration of the degree of macrovascular invasion, and its positioning of transarterial radioembolization (TARE) and external radiation, including stereotactic body radiation therapy (SBRT), as first-line ablative options for selected patients with solitary HCC.

BEACON-HCC also classifies extensive multifocal disease as advanced even when disease remains confined to the liver.

These differences reflect a broader distinction between the frameworks: BCLC retains a relatively simple stage-based structure, whereas BEACON-HCC uses a more granular treatment-allocation approach.

How does BEACON-HCC approach radiation?

Co-author Jeffrey Meyer, MD, a radiation oncologist at Johns Hopkins, said earlier BCLC versions did not recognize radiation as a major treatment option.

BEACON-HCC incorporates external beam radiation therapy (EBRT) and TARE into treatment allocation, including as primary treatment options or in combination with other therapies in selected patients.

TARE and EBRT are distinct treatment modalities: TARE delivers radiation through a transarterial approach, whereas EBRT, including SBRT, delivers radiation externally.

How does BEACON-HCC differ from the updated BCLC approach?

Both frameworks attempt to address increasing complexity in HCC treatment, but they use different approaches.

The 2026 BCLC update preserves the stage-based model, with each disease stage remaining linked to an evidence-based first-line treatment option. It also added the CUSE framework to help multidisciplinary teams address situations in which treatment decisions are complicated by uncertainty, patient-specific factors, or competing therapeutic goals.

BEACON-HCC instead focuses on more detailed treatment allocation based on tumor and clinical characteristics.

Thus, the publication of BEACON-HCC does not represent a formal transition from an outdated BCLC system to a replacement framework. Both systems are evolving approaches to treatment decision-making, with different structures for incorporating clinical complexity.

How was the 96.6% vs 72.4% concordance figure calculated?

The analysis included 29 de-identified patient cases containing clinical information and imaging.

The 20 BEACON-HCC co-authors and a separate panel of 18 outside North American HCC experts independently reviewed the cases and selected a treatment approach. Those treatment decisions were then compared with the treatment recommendations generated by BEACON-HCC and BCLC 2025.

The resulting concordance was 96.6% for BEACON-HCC and 72.4% for BCLC 2025.

These figures represent agreement with expert treatment selections in a small retrospective pilot comparison. They do not demonstrate improved survival, treatment efficacy, or patient outcomes with BEACON-HCC. The authors describe prospective validation as a next step.

Has BEACON-HCC drawn any early criticism?

An early critique appeared in a Hepatology Viewpoint by Johnson, Holden, and Turk, representing a large US multidisciplinary HCC program. They reported that their own treatment decisions were more concordant with BEACON-HCC than with BCLC, but also identified areas of concern with the new framework.

Their primary concern was BEACON-HCC's deemphasis of Eastern Cooperative Oncology Group (ECOG) performance status. They argued that the same ECOG score can reflect different circumstances—including baseline functional limitations, cirrhosis-related impairment, or recent tumor-related decline—that may have different implications for treatment selection.

In their practice, they said ECOG performance status is interpreted in its clinical context rather than used as an isolated measure.

They also highlighted structural differences between the frameworks, including BEACON-HCC's separation of extrahepatic spread from macrovascular invasion, its stratification by degree of vascular invasion, its distinction between solitary and multiple tumors, and its treatment positioning for radiation and TARE.

Is BEACON-HCC intended to replace BCLC?

No. BEACON-HCC is presented as a complementary framework for multidisciplinary decision-making rather than a replacement for BCLC.

Meyer described it as a tool for tumor board and clinical discussions, while co-author Marina Baretti, MD, of Johns Hopkins, described it as a dynamic framework intended to evolve alongside new therapies.

That positioning is also important in light of the 2026 BCLC update. BCLC remains an established framework for prognostic assessment and treatment selection and has continued to evolve, including through the addition of CUSE.

In other words, the publication of BEACON-HCC does not mark a formal transition from 1 universally accepted algorithm to another. Rather, the 2 frameworks offer different ways of structuring increasingly complex HCC treatment decisions.

What do these differences mean clinically?

The differences between BEACON-HCC and BCLC are most relevant in patients whose disease does not fit neatly into a single treatment pathway. By considering factors such as the extent of vascular invasion, tumor distribution, and the availability of local therapies, BEACON-HCC can generate treatment options that may differ from those suggested by a traditional stage-based approach.

However, the framework has not yet been prospectively validated to determine whether treatment decisions made using BEACON-HCC lead to better clinical outcomes. Its initial validation assessed concordance with expert treatment decisions, rather than patient outcomes.

What's next for BEACON-HCC?

Prospective validation through the HCC-Live Consortium is planned. That work would build on the retrospective pilot comparison used in the initial publication and provide additional information about how the framework performs across broader patient populations and clinical settings.

The broader question is how treatment-allocation frameworks should adapt as HCC therapy continues to expand. The 2026 BCLC update and BEACON-HCC represent 2 different approaches to that problem: BCLC maintains a stage-based framework while adding a structured method for navigating uncertainty, whereas BEACON-HCC places greater emphasis on detailed treatment allocation across tumor and clinical characteristics.

References

1. Singal AG, Agopian VG, Dawson LA, et al; HCC-Live Steering Committee. BEACON-HCC: best evidence and North American consensus on treatment allocation for hepatocellular carcinoma. Hepatology. Published online August 7, 2026. doi:10.1097/HEP.0000000000001834.

2. Johnson MS, Holden JH, Turk AA. BEACON-HCC through the lens of a large U.S. multidisciplinary program. Hepatology. Published online August 27, 2026. doi:10.1097/HEP.0000000000001850.

3. Reig M, Sanduzzi-Zamparelli M, Forner A, et al. BCLC strategy for prognosis prediction and treatment recommendations: the 2026 update. J Hepatol. 2026;84:631-654.

4. Chan LL, et al. What's next after the 2026 BCLC update? J Hepatol. 2026.

5. HCC-LIVE consortium publishes treatment framework for hepatocellular carcinoma. The Cancer Letter. August 14, 2026.

6. Hepatology publishes landmark North American framework to advance treatment decisions for liver cancer. American Association for the Study of Liver Diseases. August 7, 2026.