Changing paradigm for treatment strategy in intermediate-stage HCC with high tumor burden. Until recently, transarterial chemoembolization (TACE) was only the standard of care for intermediate-stage HCC. However, first-line lenvatinib followed by locoregional therapy such as selective TACE, resection, or ablation may be a suitable treatment option for intermediate-stage HCC with high tumor burden. pts, patients; LEN, lenvatinib.