Lenvatinib or Regorafenib for Advanced Hepatocellular Carcinoma After Immunotherapy (REVIVE)

Inclusion Criteria: * Age 19 years or older * Diagnosis of hepatocellular carcinoma according to the American Association for the Study of Liver Diseases (AASLD) guidelines * Unresectable or metastatic hepatocellular carcinoma not amenable to curative treatments such as surgical resection, liver transplantation, or local ablation * Prior first-line systemic treatment with an immune checkpoint inhibitor-based combination regimen, defined as dual immune checkpoint inhibitor therapy (e.g., nivolumab plus ipilimumab or durvalumab plus tremelimumab) for the REVIVE-1 cohort, and immune checkpoint inhibitor-based combination therapy (e.g., atezolizumab plus bevacizumab, durvalumab plus tremelimumab, nivolumab plus ipilimumab, camrelizumab plus rivoceranib, or similar regimens) for the REVIVE-2 cohort; prior participation in clinical trials using these regimens is allowed * Radiologic disease progression after at least 2 cycles of first-line treatment * At least one measurable lesion according to RECIST v1.1 * Recovery from toxicities related to prior therapy to grade 1 or lower, except for clinically stable or non-clinically significant toxicities * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 * Life expectancy of at least 12 weeks * Absolute neutrophil count ≥ 1.0 × 10⁹/L * Platelet count ≥ 75 × 10⁹/L for REVIVE-1 or ≥ 50 × 10⁹/L for REVIVE-2 * Hemoglobin ≥ 9 g/dL * Serum creatinine ≤ 1.5 × ULN or creatinine clearance ≥ 40 mL/min * Proteinuria \<3 g in 24…